Abstract
Shock may result from a number of distinct disease processes and it is commonly associated
with trauma, infection and cardiovascular dysfunction. Shock results in significant
morbidity and mortality and is a leading cause of death in hospital patients. In order
to improve patient outcomes it is important to recognize shock early, then assess
and treat the shocked patient in a systematic way. While the cause of the shocked
state is sometimes obvious, in more difficult situations the use of the clinical classification
of shock into cardiogenic, obstructive, hypovolaemic or distributive shock can help
the clinician to discover the underlying cause of the shock. However, it is important
to note that while this is a framework in practice there if often considerable overlap
between these different types of shock in clinical practice. After identification
of patients in shock, immediate life-saving resuscitation with directed therapy to
prevent further deterioration, worsening organ failure and to improve outcome is vital.
An ABCDE approach can be a useful systematic way for initial assessment and resuscitation.
Basic monitoring should be instituted as soon as possible and in severe or unresponsive
shock this should be escalated to invasive monitoring. Immediate generic laboratory,
microbiological and radiological tests should be carried out as soon as possible and
should include a blood lactate level. Further targeted tests should then be tailored
to the history, clinical findings and presumed aetiology of the shocked state. These
targeted investigations should help to pin point the specific cause of the shock and
guide definitive management.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Anaesthesia & Intensive Care MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The global burden of injuries.Am J Public Health. 2000; 90: 523-526
- Surviving Sepsis Campaign: International Guidelines for management of severe sepsis and septic shock: 2012.Crit Care Med. February 2013; 41: 580-637
- Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care.Crit Care Med. Jul 2001; 29: 1303-1310
- Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock.JAMA. 2005; 294: 448-454
- Septic shock: particular type of acute circulatory failure.Crit Care Med. 1990; 18: S70-S74
- Early goal-directed therapy in the treatment of severe sepsis and septic shock.N Engl J Med. 2001; 345: 1368-1377
- Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries.N Engl J Med. 1994; 331: 1105-1109
- Anaphylaxis: quintessence, quarrels, and quandaries.Emerg Med J. 2001; 18: 328
- Norepinephrine or dopamine for the treatment of hyperdynamic septic shock?.Chest. 1993; 103: 1826-1831
- The effectiveness of right heart catheterisation in the initial care of critically ill patients.JAMA. 1996; 276: 889-897
- Intrathoracic blood volume accurately reflects circulatory volume status in critically ill patients with mechanical ventilation.Intensive Care Med. 1992; 18: 142-147
- Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution.Intensive Care Med. 2000; 26: 180-187
- Lactate: may I have your votes please?.Intensive Care Med. 2001; 27: 6-11
Article Info
Publication History
Published online: January 29, 2017
Royal College of Anaesthetists CPD Matrix: 2C03Identification
Copyright
© 2016 Published by Elsevier Ltd.
