Intravascular volume and oxygen carrying capacity should be optimized. Blood products may be required. Determination of the site and etiology of hemorrhage is critical to guide further interventions and definitive care. Control of hemorrhage may be achieved in the ED or may require consultation and special interventions. Vasopressors - These agents augment both coronary and cerebral blood flow present during the low flow state associated with shock.
Hemodynamic effect is dependent on the dose.
Lower doses predominantly stimulate dopaminergic receptors that in turn produce renal and mesenteric vasodilation. Cardiac stimulation and renal vasodilation produced by higher doses. As a result, systemic blood pressure and coronary blood-flow increases. After obtaining a response, the rate of flow should be adjusted and maintained at a low normal blood pressure, such as 80-100 mm Hg systolic, sufficient to perfuse vital organs. However, vasoconstriction also is increased in splanchnic, portal, coronary, cerebral, peripheral, pulmonary, and intrahepatic vessels.