Last reviewed:December 2019
Last updated:December  2019



History and exam

Key diagnostic factors

  • presence of risk factors
  • altered cognition/agitation
  • hypotension

Other diagnostic factors

  • tachypnoea
  • tachycardia
  • prolonged capillary refill time
  • oliguria
  • muscle weakness
  • cyanosis
  • cool extremities
  • evidence of trauma
  • petechial rash
  • chest pain
  • fever
  • abdominal pain
  • jugular venous distension (JVD)
  • peripheral oedema
  • absent breath sounds on one side of chest
  • tracheal deviation
  • quiet heart sounds
  • flaccid paralysis of lower limbs
  • cardiac murmur
  • distended bladder
  • facial and tongue swelling
  • urticarial rash
  • pelvic pain/vaginal bleeding in woman of childbearing age

Risk factors

  • increasing age
  • comorbidities
  • myocardial infarction
  • cardiomyopathy
  • heart valve disease
  • arrhythmias
  • trauma
  • gastrointestinal bleeding
  • ruptured abdominal aortic aneurysm
  • burns/heat stroke
  • gastrointestinal losses: diarrhoea and vomiting
  • pancreatitis
  • sepsis
  • anaphylaxis/poisoning
  • spinal or brainstem injury
  • endocrine disease
  • pulmonary embolism
  • cardiac tamponade
  • new medicine (anaphylactic shock)

Diagnostic investigations

Treatment algorithm


Samuel J. Stratton


Fielding School of Public Health

David Geffen School of Medicine at UCLA

Los Angeles

Deputy Health Officer

Orange County Health Care Agency

Health Disaster Management/Emergency Medical Services

Santa Ana



SJS declares that he has no competing interests.

Dr Samuel J. Stratton wishes to gratefully acknowledge Dr Christoph Pechlaner and Dr Christian Wiedermann, previous contributors to this topic. CP and CW declare that they have no competing interests.

Peer reviewersVIEW ALL

Consultant in Accident & Emergency Medicine

St Helens & Knowsley Hospitals NHS Trust

Whiston Hospital




PN declares that he has no competing interests.

Vice-Chair and Program Director

Wright State University Department of Emergency Medicine




JB declares that he has no competing interests.

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