Synopsis
Identify inadequate tissue perfusion, distinguish its dominant mechanism, and choose targeted resuscitation while repeatedly checking benefit, fluid tolerance and the need for definitive intervention.
- Shock is inadequate tissue perfusion; a preserved blood pressure does not exclude it.
- Distinguish hypovolaemic, distributive, cardiogenic and obstructive mechanisms, recognising that several may coexist.
- Use history, peripheral perfusion, jugular venous pressure, lungs and focused ultrasound to direct treatment.
Key red flags
Persistent hypotension with altered mentation or worsening peripheral perfusion requires immediate senior and critical-care assessment.
Investigation priorities
Estimate physiological disturbance and follow the treatment response.
Management branches
A hypotensive adult has not yet had the principal cause of shock established.
- Support oxygenation, obtain large-bore access and ask about bleeding, infection, allergy, cardiac symptoms and recent procedures while a colleague starts monitoring.
- Examine the lungs, neck veins and peripheral perfusion before selecting fluid; treat an immediately reversible obstruction or uncontrolled external haemorrhage when identified.
Key medicines
Isotonic crystalloid for suspected sepsisGive 250 mL IV over 10–15 minutes initially; reassess after each bolus and repeat if needed up to 1,000 mL total including earlier fluids, then seek senior advice if improvement remains insufficient.Assess for contraindications and overload before and after each bolus. This sepsis-specific regimen is different from general non-haemorrhagic fluid resuscitation and active traumatic bleeding management.