Shock: Recognition & First Moves

• Shock is inadequate tissue perfusion. Use warm/cold and congestion findings as bedside clues, then combine them with the history, perfusion markers and focused ultrasound; mechanisms may overlap.
• Suspect shock with altered mentation, oliguria, abnormal peripheral perfusion or rising lactate, with or without hypotension; do not wait for lactate to reach 4 mmol/L.
• Focused cardiac and lung ultrasound helps identify ventricular failure, congestion and obstruction, but no single ultrasound sign defines the shock mechanism.
• Treat the cause: norepinephrine is first-line in septic shock, immediate IM adrenaline is first-line in anaphylaxis, and obstructive causes need urgent mechanical or reperfusion treatment.
• Before giving more fluid, use a dynamic test that is valid for the patient and reassess perfusion and fluid tolerance; individualize resuscitation targets.

First tests: Blood glucose, Blood lactate, 12-lead ECG, Bedside echocardiography, Full blood count, Sodium, potassium, bicarbonate, urea and creatinine.

Only if indicated: Blood cultures, Blood group and crossmatch.

Repeat monitoring: Blood lactate, Urine output and fluid balance.

• Principal Etiologies of Shock
• Less Common and Mixed Causes of Shock