Shock is a state of circulatory collapse leading to reduction in delivery of oxygen and other nutrients to vital organs which if prolonged leads to irreversible multiple organ failure.

CAUSES

• Excessive haemorrhage - trauma, peptic ulcer
• Excessive fliud loss - diarrhoea, vomiting, burns
• Acute myocardial infarction

SYMPTOMS

• Feeling faint
• Palpitations
• Sweating
• Restlessness
• Clouding of consciousness

SIGNS

• Pallor
• Cold extremities
• Tachycardia
• Hypotension Systolic BP <90 mmHg

TREATMENT

(Evidence rating: C)

Hypovolaemic shock

• Insert the largest bore cannula in the largest vein visible. You may insert 2 cannulae at separate sites for rapid IV infusion

• Raise drip stand or squeeze bag to increase infusion rate

• Give colloids (e.g. Dextran 70)

• If not available give crystalloids e.g. Sodium Chloride 0.9%. Aim to give in Adults: 70 ml/kg body weight; Children: 30 ml/kg body weight.(see section on management of severe dehydration)

• In haemorrhagic states cross-matched blood is preferred but time-consuming so rescucitate with above

• Fluid should be given quickly and slowed only when BP rises and urine flow is adequate.

• Catheterise the bladder

• GIVE OXYGEN 6 L/min via nasal or facial masks

• Continue to monitor BP, pulse and urine output

REFER

• CARDIOGENIC SHOCK Refer to a higher level health facility
• ANAPHYLACTIC SHOCK See section on Anaphylactic shock