Shock

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Last reviewed: 1 Apr 2025
Last updated: 25 Feb 2025

Summary

Definition

History and exam

Key diagnostic factors

  • altered cognition/agitation
  • hypotension
Full details

Other diagnostic factors

  • tachypnea
  • tachycardia
  • prolonged capillary refill time
  • oliguria
  • muscle weakness
  • cyanosis
  • cool extremities
  • evidence of trauma
  • petechial rash
  • chest pain
  • fever
  • abdominal pain
  • jugular venous distention
  • peripheral edema
  • 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
Full details

Risk factors

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

Diagnostic tests

1st tests to order

  • lactate (arterial blood gas)
  • blood gases
  • CBC
  • BUN and creatinine
  • serum electrolytes
  • coagulation studies (INR, activated PTT)
  • blood glucose
  • anion gap
  • CRP
  • ECG
Full details

Tests to consider

  • chest x-ray
  • focused assessment with sonography for trauma scan
  • echocardiography
  • procalcitonin
  • end tidal carbon-dioxide (capnography)
  • ultrasound of thorax
  • ultrasound of abdomen
  • CT thorax, abdomen, and pelvis
  • computed tomographic pulmonary angiography
  • urinalysis and urine pregnancy test
  • pelvic ultrasound
  • x-ray long bones
  • x-ray spine
Full details

Treatment algorithm

ACUTE

all patients

Contributors

Expert advisers

Samuel J. Stratton, MD, MPH

Professor

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

CA

Disclosures

SJS declares that he has no competing interests.

Peer reviewers

Patrick Nee, FRCP, FRCS, FCEM

Consultant in Accident & Emergency Medicine

St Helens & Knowsley Hospitals NHS Trust

Whiston Hospital

Prescot

UK

Disclosures

PN declares that he has no competing interests.

James Brown, MD, MMM

Vice-Chair and Program Director

Wright State University Department of Emergency Medicine

Dayton

OH

Disclosures

JB declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014 Dec;40(12):1795-815.Full text  Abstract

Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021 Nov;47(11):1181-247.Full text  Abstract

McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-726.Full text  Abstract

Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 May 3;79(17):e263-421.Full text  Abstract

van Diepen S, Katz JN, Albert NM, et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation. 2017 Oct 17;136(16):e232-68.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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