Summary
Definition
History and exam
Key diagnostic factors
- hipotensión
- taquicardia
- cambios en la piel
- oliguria
- cambios en el estado mental
- presencia de factores de riesgo
- fiebre
- dolor torácico
- disnea
- hipoxemia
- hipotermia
Other diagnostic factors
- dolor abdominal
- edema periférico
- presión venosa yugular (PVY) elevada
- ruidos cardíacos amortiguados o silenciosos
- Arritmia
- erupción petequial
- erupción urticaria
- angioedema
- reducción de los ruidos respiratorios en un lado del pecho
- Desviación traqueal
- vejiga distendida
- parálisis flácida de las extremidades
Risk factors
- mayor edad
- comorbilidades
- infarto de miocardio
- cardiomiopatía
- enfermedad de válvula cardíaca
- arritmias
- traumatismo
- sangrado gastrointestinal
- rotura de aneurisma aórtico abdominal
- quemaduras/golpes de calor
- pérdidas gastrointestinales: diarrea y vómitos
- pancreatitis
- sepsis
- anafilaxia/envenenamiento
- lesión de la médula espinal o del tallo cerebral
- enfermedad endocrina
- embolia pulmonar
- taponamiento cardíaco
- inducido por medicamentos
Diagnostic investigations
1st investigations to order
- lactato (de la gasometría arterial)
- gasometría venosa (GV) o gasometría arterial (GA)
- glucosa
- hemograma completo
- urea y electrolitos
- estudios de coagulación
- proteína C-reactiva
- procalcitonina
- electrocardiograma (ECG)
Investigations to consider
- radiografía de tórax
- Análisis de orina y prueba de embarazo en orina
- cribado de infección
- Ecografía en el punto de atención
- TC de tórax, abdomen y pelvis
- Angiografía pulmonar por tomografía computarizada (APTC)
- radiografía de los huesos largos
- radiografía de la columna vertebral
Treatment algorithm
todos los pacientes
Contributors
Expert advisers
Alexander Alexiou, MBBS, BSc, DCH, FRCEM, Dip IMC RCSEd
Emergency Medicine Consultant
Barts Health NHS Trust
Physician Response Unit Consultant
London’s Air Ambulance
Royal London Hospital
UK
Disclosures
AA declares that he has no competing interests.
Clovis Rau, MBBS, BSc, FRCEM DipIMC
ST6 Emergency Medicine
Barnet Hospital
Royal Free NHS Foundation Trust
UK
Disclosures
CR declares that he has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:
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
Paul Frost
Reader (clinical)
Centre for Medical Education
School of Medicine
Cardiff University
Honorary Consultant in Intensive Care Medicine
University Hospital of Wales
Cardiff
UK
Disclosures
PF declares that he has no competing interests.
Michael Toolis, MBBS, FCICM, GDipClinUS
Consultant Intensivist
Monash Health
Melbourne
Australia
Disclosures
MT declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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
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
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
National Institute for Health and Care Excellence. Suspected sepsis: recognition, diagnosis and early management. Mar 2024 [internet publication].Full text
National Institute for Health and Care Excellence. Intravenous fluid therapy in adults in hospital. May 2017 [internet publication].Full text
National Institute for Health and Care Excellence. Major trauma: assessment and initial management. Aug 2023 [internet publication].Full text
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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