Ebola Virus Disease: Persistent Shock After Initial Fluid Resuscitation
This protocol addresses patients with Ebola virus disease who remain in shock after initial oxygen therapy, intravenous fluid resuscitation, and empiric antimicrobial treatment — when first-line perfusion targets have not been restored.
Clinical Scenario
Shock is defined as:
- Adults: systolic blood pressure < 90 mm Hg, or clinical signs of hypoperfusion
- Children: delayed capillary refill > 3 seconds, cold extremities, weak rapid pulse, or hypotension for age
When Initial Treatment Has Not Restored Perfusion
Following oxygen therapy, isotonic crystalloid boluses (Ringer's lactate or 0.9% saline), and empiric antimicrobials, if re-assessment every 30 minutes shows that perfusion targets remain unmet — systolic blood pressure still below 90–100 mm Hg in adults (or age-appropriate values in children), SpO₂ below 94%, inadequate urine output, or ongoing clinical signs of hypoperfusion — escalation to the next management step is required.
Next Step
Vasopressor infusion is initiated to restore and maintain blood pressure and organ perfusion. The specific agent of choice differs between adult and pediatric patients. Complete agent selection, titration parameters, and the full escalation algorithm are available in the structured protocol.
References
Shock in adult: SBP < 90 mm HG, mean arterial blood pressure < 65 mm Hg or other clinical signs of hypoperfusion.
Shock in child: delayed capillary refill > 3 seconds, cold extremities, weak rapid pulse or hypotension for age (SBP < 70 + (age in years x 2)).
For adults, noradrenaline is the first-line vasopressor for shock.
For children, epinephrine is first-line vasopressor for shock. The alternative is noradrenaline.
Vasopressors can be started during fluid resuscitation and weaned as a patient responds to volume resuscitation to maintain SBP > 90–100 mm Hg in adults (or MAP > 65 mm Hg), and age-appropriate blood pressure and perfusion markers in children.
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