Shock Position - Research Help Request for Protocols

[AnthonyM83]

When we discussed this topic before, I emailed our EMS office inquiring about reasoning of our protocols which still indicate shock position. Today, my contact person sent me an email asking if I had resources or actual sources for this issue, so that we might address it with the LA EMS community.

To me, the fact they're actually interested in even considering a more progressive protocol (such as contraindicating shock position for traumas) and that they're taking input from an outsider is exciting to me. We might just move from 1980's medicine to 1990's medicine! So, I want to do my best on this.

I'd appreciate this community's help. I'm interested in:

-Any journal articles discussing the effectiveness or ineffectiveness of shock position

-Effectiveness for different types of shocks (Ex: Heard it's good for psychogenic/fainting shock, but not hypovolemic shock)

-Hazards that shock position might have in different situations

-Copies of PROTOCOLS if your agency has done away with shock position or limited it to certain cases

-Citations about shock (I know some protocols provide reference articles backing up every protocol they have or maybe more reference citations at the end of a JEMS article)

I know we had some in the old thread, but honestly those articles were lacking. One of them actually said shock position worked in majority of test subjects.

[BEorP]

In Ontario, it was recently removed from our Patient Care Standards manual. Unfortunately I cannot copy and paste the note about the revision, but it is on page four of the document below:

Link

[captainstandup]

I havent seen a "shock position" in protocols for years. You eluded to different circumstances to which i would add the following:

Remember to consider the effects of the spine feet high position due to possible complications. This is especially true in late third trimester females who connot tolerate supine positoning due to vascular compression and discomfort. CHF patients generally will not lie flat and certainly wont allow elevation of lower extremities.

[JPINFV]

http://www.emtcity.com/phpBB2/viewtopic.php?t=2875

There are a handful of studies posted in there. PM me if you need access to any full studies [scienceDirect, for example, only lets visitors look at the abstract] and I'll see what I can do.

[AnthonyM83]

No one else has protocols without shock position....

Is modifying/updating this protocol something people agree with...?

[EchoDBravo]

I transported a 75 year old patient to the hospital whose lungs were wet bilaterally and a BP of 7030. Being a Basic/Basic crew, and transport time of about 4 minutes, ALS intercept would be out of the question. It was my partner's turn to give patient care. He first sat her all the way up, which helped her breathing. All the way to the hospital the Pulse Oximeter said 42%. Even on a NRB @ 15 LPM and after 40mg of Lasix, SpO2 readout did not change. During the transport, my partner put the Ferno 35-A in trendelenbrg. I get out and go to the back, and notice that this patient is about to look ridiculous being wheeled into the ER sitting all the way up, with knees pinned to her gut. she was shaped in a V. looked very uncomfortable.

[JPINFV]

^Ah, symptoms of cookbook teaching [you don't need to know WHY this works, just that it does. So just do what I tell you to do].

[AnthonyM83]

Was that really cookbook? Seemed like someone trying to do their best to combine two different indicated positions...maybe not the best decision, but it seemed like he understood and didn't just see "low BP!" and put the SOB pt in trendelenburg.

[AZCEP]

Did this Basic/Basic crew give the Lasix? With a hypotensive patient?

Something is being lost in the translation of this one.

No, the use of "shock position" is not included in our protocols. We are covered by the more general "treat for shock".

[JPINFV]

Was that really cookbook? Seemed like someone trying to do their best to combine two different indicated positions...maybe not the best decision, but it seemed like he understood and didn't just see "low BP!" and put the SOB pt in trendelenburg.

The problem is by not understanding HOW trendelenburg works, the partner doesn't understand why the two positions are mutually exclusive. Hence cookbook teaching [see x, do A because A couteracts X, but we won't tell you why].