Code Blue Field Guide: Shock Recognition & Management — Paramedic & CCT Clinical Reference (PDF)

The back of the truck isn't the place to be flipping through a textbook.

The Code Blue Field Guide: Shock is a 32-page clinical reference built specifically for critical care transport — the decisions you make when you're wheels-up, out of cell range, and the only clinician in the room.

It covers all four shock phenotypes from first patient contact to bedside handoff, structured around the nine questions you actually need answered during a transport: why is this patient crashing, what requires immediate action, how do I identify the phenotype at bedside, what do I ask during report, how do I interpret the labs, what do I do in what order, what do I watch en route, what do I do when something goes wrong, and how do I give a safe handoff?

The clinical content is current and specific.

The treatment section is built around the CRT-guided resuscitation framework validated by ANDROMEDA-SHOCK-2 (NEJM 2024). The vasopressor quick-reference table covers norepinephrine, vasopressin, epinephrine, phenylephrine, dobutamine, and milrinone with starting doses, titration ranges, primary indications, and watch-fors in a single scannable table. The cardiogenic shock section uses SCAI staging language so your communication with receiving teams is precise. 32 references total, selected for direct transport relevance.

The troubleshooting section alone is worth it.

Section 8 covers the complications that actually happen in transport — refractory hypotension, phenotype shift mid-flight, post-intubation hypotension, tension pneumothorax development, arrhythmia with hemodynamic compromise, vasopressor extravasation, adrenal crisis in refractory shock, and MCS device alarms (IABP, Impella, VA-ECMO). Each has a structured response sequence, not a paragraph of narrative.

Five SBAR handoff templates cover distributive/septic, cardiogenic, hypovolemic/hemorrhagic, obstructive, and mixed shock — each organized by the phenotype-specific information the receiving team actually needs, in the order they need to hear it.

This guide is written for experienced providers. If you're an ICU nurse, ED nurse, or ALS paramedic moving into critical care transport, this is the field reference you'll want for your first 90 days and beyond. Basic hemodynamic principles, pharmacology, and rhythm recognition are assumed.

It is not intended for BLS providers, students, or as a substitute for your agency's protocols or medical director authority.

Format: Instant PDF download, 32 pages. Optimized for tablet display in the field and standard letter-size print for binders or lamination. Delivered immediately to your account after purchase.

Part of the Code Blue Field Guide Series. The complete series covers 15 critical care transport domains including Cardiac Emergencies, Respiratory Emergencies, Sepsis, Trauma, Airway Management, and Post-ROSC Care — each built on the same eight-section structure and color-coded reference system. Individual chapters or bundle available.