Shock

Repeat ABCDE to assess response to treatment.[1]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. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8486643 http://www.ncbi.nlm.nih.gov/pubmed/34599691?tool=bestpractice.com [2]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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4239778 http://www.ncbi.nlm.nih.gov/pubmed/25392034?tool=bestpractice.com

• Reassess with thorough clinical examination and evaluation of vital signs every 30 minutes, which should include heart rate, blood pressure, oxygen saturations, respiratory rate, and temperature.

• Monitor urine output.

• Measure blood pressure via an arterial line if the patient fails to respond to initial treatment or needs vasoactive drugs. It provides precise, continuous monitoring, and access for arterial blood sampling.

Monitor lactate levels to help monitor response to treatment.[1]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. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8486643 http://www.ncbi.nlm.nih.gov/pubmed/34599691?tool=bestpractice.com

• The lactate level should decrease if the patient is clinically improving.

• Frequency of repeat lactate measurement depends on cause of shock and treatment given.

Tailor follow-up depending on the underlying cause of shock.

• For example, cardiogenic causes may require follow-up with a cardiologist to optimise medicines and consider any future treatment.