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the shocked patient

for ADULTS
a persistent systolic BP below 90mmHg or drops more than 40mmHg below their baseline, or a mean arterial pressure (MAP) below 65mmHg is highly suggestive of shock
a person can be in shock with a normal BP if that BP is unable to maintain tissue perfusion
- healthy young adults can maintain their BP and heart rate much longer which can hide underlying shock state!
- check for evidence of shock: serum lactate, urine output, tachycardia, cold, clammy skin, pale lips, shallow rapid breathing, etc
- check for causes including less evident ones such as occult bleeding (eg. ruptured ectopic pregnancy), cold sepsis, PE
a Shock Index (heart rate/systolic BP) > 0.7 suggests early shock and if > 1.0 suggests a shock state
these patients usually need to be moved to a resuscitation cubicle for urgent care

see also:

sepsis / septicaemia
anaphylaxis
blood loss:
- trauma
- upper GIT bleeding
- lower GIT bleeding
- retroperitoneal bleeding
  - abdominal aortic aneurysm (AAA)
  - thoracic aortic aneurysm
  - ruptured splenic artery aneurysm
  - ruptured iliac artery aneurysm
  - renal bleeding eg. ruptured renal artery aneurysm
  - spontaneous retroperitoneal bleeding on anticoagulants
- haemoperitoneum
  - ectopic pregnancy
  - ruptured splenic artery aneurysm (mainly in pregnancy and elderly - 1% of adults have splenic artery aneurysms)
  - ruptured subcapsular hepatic adenoma (mainly ruptures in pregnancy in those who were previously on OCPs)
- PV bleeding in late pregnancy - abruption, placenta praevia, etc
- post-partum / puerperial complications eg. paravaginal or supravaginal haematoma
dehydration
heat illness and heat stroke
cardiogenic shock
with bradycardia
- impaired cardiac output due to the bradycardia
- cervical shock in miscarriage
- cyanide poisoning