Shock

Name the pump, the tank, the pipes, or the obstruction.

Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

Shock is hypoperfusion, not a blood-pressure number.
Assign the box with RUSH/POCUS: empty tank, broken pump, leaky pipes, obstruction.
Fluids help hypovolemic and distributive shock; they harm wet cardiogenic and the obstructed RV. In septic shock, use balanced crystalloid then dynamic reassessment; start norepinephrine if MAP remains low during resuscitation.

RUSH/POCUS: pump, tank, pipes, sliding, DVT
ECG, SpO₂, glucose, lactate
Finger thoracostomy / pericardiocentesis when the ultrasound diagnosis is made in extremis

Obstructive shock (tamponade, tension PTX, massive PE)
POCUS first: effusion with RA/RV collapse, absent lung sliding, RV strain. Needle/finger thoracostomy, pericardiocentesis, or reperfusion — not a 30 mL/kg bolus.
Cardiogenic shock
Wet, cool, JVP up, B-lines, poor LV — cautious fluids, vasopressors (norepinephrine), urgent revascularization if ACS (2025 ACC/AHA ACS).
Septic / distributive shock
Antibiotics within 1 h. Use balanced crystalloid for initial resuscitation, then dynamic reassessment to guide further fluid. Start norepinephrine if MAP remains low (SSC 2026).
Neurogenic shock
Hypotension with warm dry skin after spinal injury — fluids then norepinephrine; do not treat as hypovolemia alone.
Hemorrhagic / hypovolemic shock
Blood, source control, TXA in trauma/PPH per pathway; do not dilute with litres of crystalloid in exsanguination.

Admit (HDU)

Resolved occult hypoperfusion under monitoring, treated infection with improving lactate, compensated cardiogenic states pending further testing.

ICU / theatre / cath lab / IR

Any shock needing vasopressors, airway, massive transfusion, reperfusion, or source-control surgery.