⚡ Recognition — Shock = Inadequate Tissue Perfusion
🔎 Shock Classification — Bedside Differentiation
Distributive
Warm extremities
↑ HR, ↓ SVR
Bounding pulse
↑ CO, ↓↓ MAP
Sepsis · Anaphylaxis
Cardiogenic
Cold, clammy
↑ SVR, ↓ CO
JVD, crackles
S3, pulm edema
AMI · Acute HF
Obstructive
JVD + hypoxia
Tracheal deviat.
Pulsus paradoxus
Beck's triad
PE · Tamponade · PTX
Hypovolemic
Dry mucosae
↑ HR, flat JVP
Tenting skin
↓ Hct (hemorrh.)
Hemorrhage · GI loss
📊 Hemodynamic Profile (PA Catheter / Echo)
■ Distributive
■ Cardiogenic
■ Obstructive
■ Hypovolemic
⚕ Universal Resuscitation Algorithm (First 15 Minutes)
1
Airway/Access: 2x large-bore IVs, O₂, cardiac monitor, 12-lead ECG, portable CXR — Immediate
2
Volume Challenge: 250–500 mL crystalloid over 15 min → reassess MAP, CO, lung sounds. Stop if PCWP ↑ or O₂ sat ↓
3
MAP Target: ≥ 65 mmHg (≥ 70–85 if chronic HTN). Start Noradrenaline if MAP < 65 after fluid
4
Point-of-care Echo: Assess LV/RV function, IVC collapsibility, pericardial effusion → guides type-specific therapy within 5 min
5
Treat Cause: Cultures + Abx (septic) · PCI/dobutamine (cardiogenic) · Needle/pericardiocentesis (obstructive) · Transfuse Hb<7 (hemorrhagic)
💊 Vasopressors & Inotropes — Shock-Specific
Distributive (Septic)
Noradrenaline 0.1–1 mcg/kg/min 1st line
Vasopressin 0.03 U/min add-on
Hydrocortisone 200 mg/day if refractory
Adrenaline add-on if MAP not met
Cardiogenic
Dobutamine 2.5–20 mcg/kg/min
Noradrenaline if MAP < 65
Avoid aggressive fluids
IABP / ECMO if refractory
Anaphylactic
Adrenaline IM 0.5 mg q5min
Adrenaline IV 0.1–0.5 mcg/kg/min
1L NS bolus immediately
Chlorphenamine + Hydrocortisone
🚨 Do Not Miss — Immediately Reversible Causes
⚡Tension PTX — Needle decompression 2nd ICS MCL, then chest tube NOW
⚡Cardiac Tamponade — Pericardiocentesis if hemodynamically compromised
⚡Massive PE — Systemic thrombolysis: Alteplase 100 mg over 2h
⚡Adrenal Crisis — Hydrocortisone 100 mg IV + aggressive fluids immediately
⚡Aortic Dissection — Avoid thrombolytics; emergent surgery/stenting
⚡Anaphylaxis — IM Adrenaline is 1st line, NEVER delay; IV line second