🚑 EmergencyCritical careStudentInternResident

Shock

Also known as: circulatory shock · hypovolaemic shock · cardiogenic shock · distributive shock

Life-threatening circulatory failure with inadequate tissue perfusion. Recognise it early, restore perfusion, and treat the type-specific cause.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Anyone acutely ill or injured — from bleeding, sepsis, cardiac failure, anaphylaxis, or obstruction (PE, tamponade, tension pneumothorax).

Red flags — escalate / refer

Hypotension with hypoperfusion (altered mental state, cool/mottled skin, low urine output, rising lactate) → resuscitate now and identify the shock type.

Work-up / diagnosis

1ABC with continuous monitoring; identify the TYPE — hypovolaemic (bleeding/fluid loss), distributive (sepsis, anaphylaxis, neurogenic), cardiogenic (pump failure), or obstructive (PE, tamponade, tension pneumothorax).
2Use bedside tools: lactate, point-of-care ultrasound, and ECG.

Management — overview

Airway/breathing/oxygen; large-bore IV access; treat the cause.
Hypovolaemic: control bleeding plus fluids/blood. Distributive/septic: fluids + early antibiotics + vasopressors (see Sepsis); anaphylaxis: adrenaline (see Anaphylaxis).
Cardiogenic: cautious fluids, inotropes/vasopressors, and treat the cause (reperfuse ACS, correct arrhythmia). Obstructive: relieve the obstruction (thrombolyse PE, drain tamponade, decompress a tension pneumothorax).
Titrate to perfusion (MAP, urine output, lactate clearance); escalate to critical care.

In-depthFull dosing & advanced protocol

Drug dosing

IV fluids / blood (type-appropriate)

Restore perfusion

Adult dose: Blood for haemorrhage; crystalloid for sepsis/hypovolaemia; cautious in cardiogenic shock
Route: Intravenous

OtherSurviving Sepsis Campaign — International Guidelines ↗

Vasopressor (noradrenaline)

Persistent hypotension after fluids

Adult dose: First-line; titrate to MAP ≥65 mmHg
Route: IV infusion

OtherSurviving Sepsis Campaign — International Guidelines ↗

Cause-specific therapy

Definitive treatment

Adult dose: Adrenaline (anaphylaxis), antibiotics (sepsis), reperfusion (ACS/PE), decompression (tamponade/tension pneumothorax)
Route: —

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Classify & target resuscitation

Point-of-care ultrasound helps differentiate the shock type quickly.
Assess fluid responsiveness; choose vasopressor/inotrope by type.
Obstructive shock (tension pneumothorax, tamponade, massive PE) needs an immediate mechanical fix, not just fluids.

OtherSurviving Sepsis Campaign — International Guidelines ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

AnaphylaxisAcute, life-threatening systemic hypersensitivity with airway, breathing or circulation compromise within minutes of a trigger. Intramuscular adrenaline is the immediate, life-saving treatment.Snakebite EnvenomationA medical emergency from a venomous snakebite. In India the “Big Four” (cobra, krait, Russell's viper, saw-scaled viper) cause neurotoxic and/or haemotoxic envenomation. Polyvalent anti-snake venom (ASV) is the antidote; many bites are “dry”.Sepsis & Septic ShockLife-threatening organ dysfunction from a dysregulated host response to infection. Early recognition and the “hour-1 bundle” save lives; septic shock adds fluid-refractory hypotension.

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV fluids / blood (type-appropriate)

Vasopressor (noradrenaline)

Cause-specific therapy

📈 Classify & target resuscitation

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV fluids / blood (type-appropriate)

Vasopressor (noradrenaline)

Cause-specific therapy

📈 Classify & target resuscitation

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Classify & target resuscitation

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Classify & target resuscitation

References