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There are lots of different causes of shock but if you are in doubt, the most common and therefore the one you should treat it as, is this one: hypovolaemic shock.
Shock due to reduction in the volume of circulating fluid. Generally, do something if the Systolic BP < 90 - that's never good.
Often, the cause of the shock is unknown and you just have to engage in some general management. Hypotension affects two bits: the sympathetic nervous system and renin-angiotensin-aldosterone system. The sympathetic nervous system causes vasoconstriction. Renin, released in the JGA of the kidney in hypotension, causes angiontensin-converting enzyme to convert angiontensin I to angiotensin II, a vasoconstrictor. This in turn causes aldosterone release in the adrenal glands, which causes salt and water retention.
Essentially, there are three bits to hypovolaemic shock which cause symptoms: tissue perfusion, increased sympathetic tone, metabolic acidosis.
- Inadequate tissue perfusion
- Increased sympathetic tone
- ECG - to identify cardiogenic shock
- Blood glucose
- Cross-match blood and check clotting
- Cultures - blood, urine
- Others: lactate, echo, abdominal CT, USS
If BP unrecordable, call cardiac arrest team.
- Give high-flow 100% O2
- Raise foot of bed - everybody always forgets this but it's quite important and can help
- IV access x 2 - wide-bore cannulae
- Treat cause
- Infuse crystalloid fast (don't do this if you know it's cardiogenic shock
Then do all your investigations. Consider putting in arterial and central line and record urinary output with a bladder catheter. Replace fluids guided by BP, CVP and urine output and consider inotropic support in hypotension.