PALS Megacode 8 In-Hospital

You have identified that the patient is experiencing compensated hypovolemic shock. Two unsuccessful attempts are made at establishing peripheral IV access. The patient continues receiving supplemental oxygen via NRB, and vitals reflect further deterioration.

An RN has started providing supplemental oxygen via NRB. The patient is attached to a cardiac monitor and pulse oximeter. You conduct a rapid, hands-on primary assessment using the ABCDE approach which reveals the following:

• Airway: Patent, open
• Breathing: RR 55/min, SpO2 99%, ineffective, lungs CTA bilaterally
• Circulation: HR 195/min, BP 75/40, delayed CRT (4 secs), weak peripheral pulse
• Disability: Conscious
• Exposure: Pale, cool, mottled, febrile (39.1 °C)

Intraosseous access has been established.

An NS 20 ml/kg fluid bolus is being administered over 5-20 min.

An NS 20 ml/kg fluid bolus is administered over 5-20 min and glucose levels are low. A repeated primary assessment reveals HR 190/min, RR 50/min, SpO2 98%, BP 70/34, CRT 4 sec, and weak peripheral pulses bilaterally.

A second NS 20 ml/kg fluid bolus is administered over 5-20 min and glucose levels are normalized. A repeated primary assessment reveals HR 170/min, RR 51/min, SpO2 98%, BP 80/40, CRT 3 sec, and slightly stronger peripheral pulses bilaterally.

A second NS 20 ml/kg fluid bolus is administered over 5-20 min and a repeated primary assessment reveals HR 155/min, RR 40/min, SpO2 98%, BP 90/45, CRT 2 sec, and normal peripheral pulses bilaterally.