2.  Give crystalloid fluids as the first-line treatment.9-14

3.  Use synthetic colloids and hypertonic saline (HTS) in dogs with refractory shock. Very limited data in dogs suggest increased risks,15-18 but dogs do not seem as sensitive to the adverse effects of these fluids as are people. Two recent studies in dogs showed no adverse side effects, specifically acute kidney injury, with tetrastarch use.19,20 The benefits outweigh the risks, so be aggressive with synthetic colloid and HTS.15-17

4.  Human serum albumin (HSA) use. Do not give HSA or other synthetic colloids (e.g., dextrans) to MWDs, because severe allergic reactions are possible (HSA) and coagulopathies are common (dextrans). Some data suggest benefit in a very limited subset of patients with severe hypoalbuminemia,22,23 but risks far outweigh potential benefit in dogs with shock.

5.  Blood product use. Canine blood products are not available for immediate HCP use.2 Dogs cannot be transfused with human blood products. HCPs will have to manage hemorrhagic shock with crystalloid and colloid therapy.

6.  Tranexamic acid (TXA) and ɛ-aminocaproic acid (EACA) use. There is limited, but promising, data to guide use of TXA24-27 and EACA28 in dogs with hemorrhage. Dogs appear to be hyperfibrinolytic compared to humans, suggesting higher doses of TXA may be needed in dogs. Consider TXA or EACA if the dog is anticipated to need significant blood transfusion, such as severe hemorrhagic shock, limb amputation, penetrating torso trauma with severe non-compressible bleeding, because canine blood products are not available. Administer these drugs as soon as possible after trauma, but NO LATER THAN 3 HOURS post injury.

7.  Targeted shock resuscitation end points that are practical for HCPs include systolic and mean arterial pressures, level of consciousness and mentation, mucous membrane color and capillary refill time, HR, RR, and pulse quality.

8.  Provide supplemental oxygen therapy. Oxygen supplementation is critical. Every shock patient should receive supplemental oxygen therapy until stable (See CPG 3).

9.  Identify and treat the cause of shock. The cause of shock must be corrected, if possible.