Classification and management of shock

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Meet the patient

A 68-year-old man arrives grey, clammy, and hypotensive. His blood pressure is 82/50, his heart rate is 128, and his skin is cool to the touch. The central question is not whether he is in shock — it is which of the four compartments has failed, because each demands a different first intervention: fluid replacement, vasoconstrictors plus fluids, cardiac drugs or intervention, or relief of the obstruction.^[1]

Classify the failed compartment at the bedside before reaching for any drug. The ESICM consensus frames the bedside questions as preload and fluid responsiveness, stroke volume or cardiac output, regional and microcirculatory markers — and 44 statements to diagnose, treat and monitor shock.^[2]

References28ShowHide

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