Notice: this content is AI-generated and has not yet been fully reviewed by the author. Do not rely on it for patient care — always verify against the linked guidance and your seniors.
A revision walkthrough — for learning, not live patient decisions. In real practice, this is a senior-supported, local-guideline call. Start the walkthrough
● worked example · learn the approach

The shocked patient

Learn to sort shock at the bedside, step by step. Recognising it early, working out which of the four types it is, and treating the cause. Built for revision, not live patient decisions.

1

Settle them, and check the basics

recognise it early

Red flags — the signs of shock

Hypotension + tachycardiacirculatory failure Cold, mottled peripherieshypovolaemic / cardiogenic Warm, bounding, flusheddistributive (septic / anaphylactic) Raised JVP + hypotensioncardiogenic or obstructive High lactate, oliguria, confusionend-organ hypoperfusion Not responding to fluidsescalate — critical care
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Pearl

Shock is inadequate tissue perfusion — and the blood pressure can still look normal early, especially in the young, who compensate until they crash. Trust the peripheries, the lactate and the urine output as much as the numbers on the monitor.

Your first moves

  • A–EAssess A–Etreat what you find as you go
  • O₂High-flow oxygenwhile you work out the cause
  • IV×2Two large-bore cannulaebloods, cultures, lactate, crossmatch
  • IVFluid challenge — then reassesscautiously if the JVP is up / cardiogenic
  • ♥ECG + monitorarrhythmia and ischaemia as a cause
  • ?Find the typethe fluid response and the JVP point the way
2

Which type of shock?

the JVP is your compass

Sort it at the bedside

  • Low JVP, responds to fluids — hypovolaemic (bleeding, fluid loss) or distributive (sepsis, anaphylaxis)
  • High JVP, worse with fluids — cardiogenic (MI, arrhythmia) or obstructive (tension pneumothorax, massive PE, tamponade)
  • Warm & vasodilated — distributive
  • Cold & clamped down — hypovolaemic or cardiogenic

Bedside ultrasound (POCUS) — the heart, the IVC, the lungs and the abdomen — rapidly narrows this down in trained hands.

Work A–E — assess and act as you go

AAirway. Angioedema or stridor → anaphylaxis.IM adrenaline, secure the airway
BBreathing. Absent unilateral sounds → tension pneumothorax.decompress immediately if suspected
CCirculation. JVP, cap refill, fluid response, ECG, and look for bleeding.fluids or blood; vasopressors if not responding
DDisability. Confusion signals hypoperfusion. Check glucose.reassess frequently
EExposure. Rash (anaphylaxis/sepsis), bleeding, source of infection, temperature.expose and find the cause
3

The four types of shock

tap to open each

What points toward it, what would confirm it, and how to manage it.

4

Investigate — what to order, when, and what it tells you

test with a question in mind

Lactate & VBG

When
Immediately.
Tells you
Severity of hypoperfusion and the trend with treatment.

ECG

When
Everyone.
Tells you
MI, arrhythmia, or right-heart strain (PE).

Bloods & cultures

Bloods
FBC, U&E, clotting, crossmatch; cultures if septic.
βhCG
If pregnancy is possible (ectopic).

POCUS / imaging

POCUS
Heart, IVC, lungs, abdomen — fast bedside sorting.
CT / CXR
Guided by the suspected cause.
5

How the plan comes together

disposition · handover

responding

Cause identified and treated, perfusion and lactate improving, stable observations.

Then: ongoing monitoring on the right ward, treat the underlying cause.

escalate / ITU

Not responding to initial treatment, needing vasopressors, or an obstructive cause needing intervention → critical care now.

Hand over: the type of shock, cause, treatment given, and the response.

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Pearl

The whole game is "which type, and what's the cause" — because the fix is completely different. Fluids save the hypovolaemic patient and drown the cardiogenic one. Nicely done getting here.