Shock

Basic Emergency Care Course

Objectives
By the end of this presentation, you will be able to:
• Recognize signs of shock and poor perfusion
• Apply a SAMPLE history to a patient with shock
• Describe how to perform a secondary exam for a patient with shock
• Assess fluid status
• Select appropriate fluid administration based on patient’s age, weight and condition
• Recognize malnourishment, anaemia and burns and adjust fluid
resuscitation accordingly
• List the high-risk causes of shock
• Describe critical actions to manage patients with shock
• Describe special paediatric considerations for shock
• Consider the disposition and transport of patients with shock
Essential skills
• Intravenous (IV) line placement
• Assessing ABCDE • IV fluid resuscitation
Overall • Secondary survey • Direct pressure/ deep wound
• Cervical spine immobilization packing for haemorrhage control
• Head-tilt and chin-lift/jaw • Tourniquet for haemorrhage
thrust control
• Airway suctioning • Pelvic binding
• Management of choking • Fracture immobilization
• Recovery position • Skin pinch test
• Nasopharyngeal (NPA) and • Uterine massage
oropharyngeal airway (OPA)
• Full spine immobilization
placement
• AVPU and Glasgow Coma
• Oxygen administration Scale assessment
• Bag-valve-mask ventilation • Glucose administration
• Needle-decompression for • Wound and burn management
tension pneumothorax • Snake bite management
• Three-sided dressing for • Log roll
chest wound
What is shock?
Poor perfusion
• The body is not able to get enough oxygen-carrying blood to vital organs.

SHOCK = Uncorrected poor perfusion

• The organs stop working properly when there is a lack of oxygen to cells and
tissue.

Infants, children and older adults are more likely to be severely affected by shock.

Shock can rapidly lead to death

!
Causes of poor perfusion
Loss of blood Abnormal relaxation and
• Haemorrhage enlargement of blood
Loss of fluid vessels
• Diarrhoea • Severe infection
• Vomiting • Spinal cord injury
• Extensive burns
©WHO/Laerdal Medical
• Severe allergic reaction
• Excessive urination Poor filling of the heart
• Poor fluid intake
Failure of the heart to
pump effectively
• Cardiogenic shock
Goals

The goal of initial assessment is to identify shock and any reversible causes of shock.

The goal of acute management is to restore perfusion (oxygen delivery to the organs)
and address ongoing fluid loss where possible.
The ABCDE Approach

!
REMEMBER …………
Always start with the ABCDE Approach AND treat life-threatening
conditions.

Then, take a SAMPLE history.

Then, do a Secondary Exam.

Key Elements in the ABCDE Approach
Airway
• Check for face or mouth swelling (allergic reaction).
• Severe allergic reaction can cause shock.

Breathing
• Wheezing can indicate allergic reaction.
• Severe allergic reaction can cause shock.
• Shock and absent breath sounds on one side (tension pneumothorax).
• DIB or increased respirations can be caused by poor perfusion
• Heart failure can cause poor perfusion and DIB
• Severe infections associated with lung inflammation can cause DIB.
Key Elements in the ABCDE Approach
Circulation
• Check for bleeding.
• From the stomach and intestines
• After childbirth
• Injuries to chest, abdomen, pelvis, long bones, bleeding wounds
• Check for fluid loss from vomiting, diarrhoea, extensive burns, excess
urination.
Disability
• Check for confusion.
• Confusion in a person with poor perfusion suggests severe shock.
• Paralysis may indicate a spinal cord injury causing shock.
Exposure
• Check for signs of bleeding, trauma, moist, cool skin.
• Look for rash or hives suggesting allergic reaction or infection.
• Keep the patient warm.
Shock

Part 1:The SAMPLE history

S: Signs and Symptoms
ASK
• Is there vomiting and/or diarrhoea?
• For how long?

©WHO/Laerdal Medical
THINK
• Fluid losses from vomiting and diarrhoea can be severe and lead to
shock.
• Knowing the amount can help you estimate how much fluid the patient
will need.
S: Signs and Symptoms

ASK
• If the person has blood in their vomit or stool

THINK ©WHO/Laerdal Medical

• Bleeding in the stomach and/or intestines can be severe before it is

visible.
• A person can lose a significant portion of their blood volume in the
intestines.
• Digested blood appears black in the vomit or stool.
S: Signs and Symptoms
ASK
• If there has been any vaginal bleeding
• Is the patient pregnant or has she been pregnant?
• When was the last menstrual period?
• Any missed periods?
©WHO/Laerdal Medical

THINK
• Vaginal bleeding may be related to pregnancy.
• A woman may not know she is pregnant in early pregnancy.
• All women are at risk for an ectopic pregnancy (pregnancy outside the uterus).
• Ectopic pregnancy rupture can happen before a woman knows she is
pregnant.
• Vaginal bleeding could also be caused from a mass in the cervix or uterus.
S: Signs and Symptoms
ASK
• If the person has had chest pain

THINK ©WHO/Laerdal Medical

• Chest pain may suggest a heart attack.

• Muscle damage to the heart can reduce pumping ability which can
cause shock.
S: Signs and Symptoms

CHECK
• For fever

THINK ©WHO/Laerdal Medical

• Fever suggests an infection.
• Severe infection causes abnormal relaxation (dilation) and leakiness of
the blood vessels which causes fluid loss into the tissues.
• This lowers blood pressure, causing shock.
S: Signs and Symptoms

ASK
• Was there any exposure to toxins,
medications, insect stings or other
substances?

THINK ©WHO/Laerdal Medical

• Severe allergic reactions can lead to shock.

• Overdose of many medications including
blood pressure and seizure medications can
cause shock.
S: Signs and Symptoms

ASK
• Is there altered mental status?
• Is there unusual sleepiness?

©WHO/Laerdal Medical

THINK
• The brain is one of the last organs to be affected by poor perfusion.
• If the brain does not have enough blood flow and oxygen to function,
this is a sign of severe shock.
A: Allergies
ASK
• Are there any allergies to medications?

THINK ©WHO/Laerdal Medical

• Severe allergic reactions can lead to shock by causing abnormal

relaxation of the blood vessels.
M: Medications
ASK
• Currently taking any medications?
• Any new medications or recent dose changes?
©WHO/Laerdal Medical

THINK
• Overdose of some blood pressure or seizure/convulsion medications can
cause shock.
• Medications that thin the blood can worsen bleeding.
• New medications or changes to medications can cause allergic reaction or
unexpected side effects.
P: Past Medical History
ASK
• History of pregnancy or recent delivery?
• History of recent surgery?
• History of heart disease (heart attack or heart valve
problem)? ©WHO/Laerdal Medical
• History of HIV?

THINK
• Shock can be from postpartum hemorrhage or ruptured
ectopic pregnancy.
• Internal bleeding or infection after surgery can cause shock.
• Patients with heart disease are at risk of worsening heart
function.
• HIV can increase the risk of infection .
L: Last Oral Intake
ASK
• When did the patient last eat or drink?

THINK
• A person who is not eating or drinking well can develop severe
dehydration.
E: Events Surrounding Illness
ASK
• Was there any recent trauma?

THINK
• Trauma can cause
• Hidden internal bleeding ©WHO/Laerdal Medical

• Tension pneumothorax
• Bruising or bleeding around the heart.
• Trauma to the neck or back can cause spinal cord injury
• Leading to problems with blood vessels’ ability to maintain
blood pressure.
E: Events Surrounding Illness
ASK
• Has there been any recent illness?

THINK ©WHO/Laerdal Medical

• Any infection can cause a blood infection that leads to shock.

Workbook Question 1

Using the workbook section above, list the six questions about signs and
symptoms you would ask when taking a SAMPLE history

1.
2.
3.
4.
5.
6.
Shock

Part 2: Secondary Exam Findings and Possible Causes

REMEMBER

!
Shock happens when there is poor perfusion.
This can happen before the blood pressure falls !
Low blood pressure with poor perfusion is a very bad sign.

The initial ABCDE approach identifies and manages life-threatening conditions.

The secondary exam looks for changes in the patient’s condition or

less obvious causes that might have been missed on the initial survey.
Look, listen and feel

Remember: You should have ALREADY completed the ABCDE Exam and

!
treated life-threatening conditions BEFORE doing this extensive
examination.

If the secondary exam identifies an ABCDE condition, STOP AND RETURN

IMMEDIATELY TO ABCDE to manage it.

Remember: Children have different normal vital sign ranges. Their vital
signs may remain normal until they are very ill.
Secondary Exam Findings
CHECK breath sounds and respiratory rate.
• Abnormal or noisy breathing can indicate pneumonia.
• High sugar levels can cause chemical imbalances that the body tries to
address by faster or deeper breathing.
• Note sweet or fruity smelling breath, elevated blood glucose, increased
urination.

LOOK for bleeding.

• All external bleeding should be controlled with DIRECT PRESSURE.
• Arterial bleeding is high pressure.
• Person can lose significant blood volume in minutes. ©WHO/Laerdal Medical

• Put gloved finger on the site and hold pressure until the bleeding stops.
• Consider vaginal bleeding as a significant source of blood loss.
Secondary Exam Findings
CHECK fluid status.
• In dehydrated states, the patient may feel
thirsty, may have dry lips and mouth, abnormal
skin pinch, lethargy and delayed capillary refill.

• Patients with heart failure can be in shock with ©WHO/Laerdal Medical

fluid overload.
• Patient may have difficulty breathing, lower
body swelling (usually legs), crackles heard
in the lungs and distended neck veins.
Secondary Exam Findings

CHECK conjunctiva (inside of lower eyelid).

• Everyone should have pink, most skin on the
inside of the eyelid.
• Pale or white conjunctiva can indicate blood
loss.
©WHO/Laerdal Medical
Secondary Exam Findings
CHECK mental status.
• Confusion in a patient with poor perfusion suggests severe shock.

CHECK for fever.

• Fever in a patient with shock suggests severe infection.

CHECK blood sugar. ©WHO/Laerdal Medical

• Low blood sugar can sometimes look like shock (without low blood
pressure).
• Give GLUCOSE if less than 3.5 mmol/L.
• If you cannot check a blood glucose and the person has altered
mental status, a history of diabetes or another reason to be
hypoglycemic (malaria, taking quinine, is very ill or malnourished),
give GLUCOSE.
Secondary Exam Findings
CHECK: for severe abdominal pain

FEEL: for a very firm abdomen

• Pain can be a sign of bleeding or infection in the
abdomen.
• In a patient that may be pregnant, this can be a sign ©WHO/Laerdal Medical
of ectopic pregnancy.
Secondary Exam Findings
CHECK urine colour and volume.
• Small amounts of darker urine may suggest
dehydration.

CHECK stool.
• Significant diarrhoea can cause dehydration.
©WHO/Laerdal Medical
• A large amount of watery “rice water” stool suggests
cholera which can lead to dehydration.
• Black, dark or reddish stool can suggest stomach or
intestinal bleeding.
Secondary Exam Findings
CHECK for malnourishment.
• A malnourished patient requires a specialized
rehydration plan.
• Be sure to ask about recent weight changes.

CHECK skin for swelling and rash.

• Swelling of mouth or body and rashes can indicate an
allergic reaction. ©WHO/Laerdal Medical

• Other rashes can indicate systemic infection.

• Swelling of both legs (oedema) can indicate heart failure.
• Sweating may occur with moderate to severe shock.
Workbook Question 2
Using the workbook section above, list what you need to CHECK in a person
with shock
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Shock
Part 2: Secondary Exam Findings and Possible Causes
Poor Perfusion Due to Dilated Blood Vessels
Severe infection
• Fever
• Tachycardia
• Tachypnoea
• May have hypotension
• May have signs of infection
• Visible infection in the skin
©WHO/Laerdal Medical
• Cough and crackles in one area of the lungs (may have fast breathing)
• Burning with urination or urine that is cloudy or foul-smelling
• Any focal point pain in association with fever
Poor Perfusion Due to Dilated Blood Vessels
Spinal cord injury
• History or signs of trauma
• Spinal pain/tenderness, vertebrae not in line
• Crepitus when you touch the spinal bones
• Movement problems including paralysis, weakness,
abnormal reflexes
• Sensation problems ©WHO/Laerdal Medical

• Unable to control urine and stool

• Priapism (persistent, abnormal erection of the penis)
• May have hypotension or bradycardia
• Difficulty in breathing (in upper c-spine injury)
Poor Perfusion Due to Dilated Blood Vessels
Severe allergic reaction
• Swelling of the mouth
• Difficulty in breathing with stridor and/or wheezing
• Skin rash
• Tachycardia
• Hypotension
©WHO/Laerdal Medical
Poor Perfusion Due to Fluid Loss
Diabetic ketoacidosis (DKA)
• History of diabetes
• Rapid or deep and slow breathing
• Frequent urination
• Sweet smelling breath
• High glucose in blood or urine
©WHO/Laerdal Medical
• Dehydration
Poor Perfusion Due to Fluid Loss
Severe dehydration
• Abnormal skin pinch
• Decreased ability to drink fluids
• Increased fluid loss
• Vomiting
• Diarrhoea
• Excessive urination
• Dry mucous membranes ©WHO/Laerdal Medical

• Tachycardia
Poor Perfusion Due to Fluid Loss
Burn injury
• Red, white or black areas depending on the depth
• May have blistering
• Consider inhalation injury

©WHO/Laerdal Medical

Burn injuries can cause excessive fluid losses through

the damaged tissues and patients can become
severely dehydrated.
Poor Perfusion Due to Blood Loss
External bleeding
• History of injury
• Active bleeding
• Use of blood thinning medication

Large bone fractures

• History of injury ©WHO/Laerdal Medical

• Pain or instability of the pelvis, blood at the opening of penis or rectum

(pelvic fracture)
• Deformity or crepitus of femur, shortening of the leg with injury (femur
fracture)
Poor Perfusion Due to Blood Loss
Abdominal bleeding
• Bruising around the umbilicus or over the flanks (internal bleeding)
• Abdominal pain
• Very firm abdomen

Bleeding in the stomach or intestines

• Blood in vomit or stool
• Black vomit or stool
• History of alcohol use

©WHO/Laerdal Medical
Poor Perfusion Due to Blood Loss
Haemothorax
• Difficulty in breathing
• Decreased breath sounds on the affected side
• Dull sounds with percussion on affected side
• Shock (if large amount of blood loss)

©WHO/Laerdal Medical
Poor Perfusion Due to Blood Loss
Ectopic pregnancy
• History of pregnancy, missed menstrual cycle, woman of child-bearing age
• Abdominal pain
• Vaginal bleeding

Post-partum haemorrhage
• Recent delivery
• Heavy vaginal bleeding
• Pad or cloth soaked <5 minutes
• Constant trickling blood
• Bleeding >250ml or delivered outside of the hospital ©WHO/Laerdal Medical

• Soft uterus/lower abdomen

Poor Perfusion Due to Heart Problems
Heart failure
• Difficulty breathing with exertion or lying flat
• Swelling to both legs
• Distended neck veins
• Crackles may be heard in the lungs
• May have chest pain

©WHO/Laerdal Medical
Poor Perfusion Due to Heart Problems
Heart attack
• Chest pressure, tightness or crushing in the chest
• Diaphoresis and mottled skin
• Difficulty in breathing
• Nausea or vomiting
• Pain moving to jaw or arms
• Signs of heart failure ©WHO/Laerdal Medical

• History of smoking, cardiac disease,

hypertension, diabetes, high cholesterol, family
history of heart problems
Poor Perfusion Due to Heart Problems
Abnormal rhythm
• Very fast or very slow pulse
• Irregular pulse

Heart valve problem

• Valve disease can damage the heart muscle
or limit blood flow
• History of rheumatic fever or heart disease
• Murmur

©WHO/Laerdal Medical
Poor Perfusion Due to Heart Problems
Pericardial tamponade
• Signs of poor perfusion
• Tachycardia, tachypnea, hypotension
• Pale skin, cold extremities
• Capillary refill greater than 3 seconds
• Distended neck veins
• Muffled heart sounds
• May have dizziness, confusion, altered mental status
• History of tuberculosis, trauma, malignancy or kidney
failure
Poor Perfusion Due to Heart Problems
Tension pneumothorax
• High pressure shifts the large blood vessels in the
chest, blocking blood flow and preventing filling of the
heart
• Hypotension WITH the following:
• Difficulty breathing
• Absent breath sounds on affected side
• Hyperresonance with percussion on affected side
• Distended neck veins
• May have tracheal shift away from affected side
©WHO/Laerdal Medical
REMEMBER…Hypoglycaemia can look like shock
Hypoglycaemia
• Sweating (diaphoresis)
• Seizures/convulsions
• Low blood glucose (<3.5mmol/L)
• Altered mental status
• History of diabetes, malaria or severe infection
• In children, can occur in any severe illness
©WHO/Laerdal Medical
Workbook Question 3
Using the workbook section, list the possible causes of shock next to
the history and physical findings below

History and physical findings Likely cause

35-year-old woman presents with shock,
fever, burning with urination and cloudy
urine
20-year-old woman presents with shock,
abdominal pain, missed menstrual cycle
and vaginal bleeding
A 17-year-old man presents after a motor
vehicle crash with shock, bruising to the
pelvis and femur fracture
Shock

Part 3: Management of shock, special considerations and disposition

Management
• For all causes of poor perfusion, establish an IV AND give
IV FLUIDS
• Use Normal Saline or Ringer’s Lactate for all adult patients
and children with normal nutritional status.
• Then work to treat underlying causes
• If you cannot place an IV consider, NASOGASTRIC tube or
intraosseous line. ©WHO/Laerdal Medical

• If patient can safely tolerate, attempt oral fluids.

REMEMBER treat ABCDE problems and life-threatening conditions first!

 ! CAUTION !
For severely malnourished or anaemic
children, or anyone with signs of
volume overload, this protocol will
need to be modified.
Management: Postpartum haemorrhage
If vaginal bleeding after delivery (postpartum
haemorrhage)

All patients need rapid HANDOVER/TRANSFER to an

advanced obstetric provider.

While awaiting transport, attempt to stop the bleeding. ©WHO/Laerdal Medical

Give OXYTOCIN both IM and IV for a loading dose.

• Continue OXYTOCIN IV INFUSION until one hour after bleeding
stops.
Management: Postpartum haemorrhage
Bleeding frequently happens if the uterus is not fully
contracted
(does not feel hard on palpation).

• Perform UTERINE MASSAGE until the uterus is hard.

• Continue OXYTOCIN.
• If the placenta delivers, collect in a leak-proof container
and send with patient to an advanced obstetric provider.
• LOOK for a perineal or vaginal tear. If found APPLY DIRECT PRESSURE.
• Even if the bleeding stops,
prepare for rapid HANDOVER/TRANSFER. ©WHO/Laerdal Medical
Management

If fluid loss is from burns

 Burns disrupt the skin barrier and can cause significant fluid loss.
 Calculate fluid replacement needs using Parkland Formula.

If suspected hyperglycaemia
 If concern for diabetic ketoacidosis (DKA), treat with IV FLUIDS. ©WHO/Laerdal Medical

 A person with DKA is extremely ill, plan for rapid HANDOVER/TRANSFER.

Management

If fever and shock

 Give IV FLUIDS and start ANTIBIOTICS.
 If infectious diarrhoea (like cholera) is suspected:
• Use gloves, aprons and relevant ISOLATION
PRECAUTIONS.
• Always report suspected cases to local public health
agency.
 If signs of poor perfusion do not improve, prepare for
rapid HANDOVER/TRANSFER.
©WHO/Laerdal Medical
Management
If suspected spinal causes
 Give IV FLUIDS.
 Prepare for rapid HANDOVER/TRANSFER for ongoing spinal care.

If suspected internal bleeding, stomach bleeding or intestinal bleeding

 Give IV FLUIDS.
 Give BLOOD or HANDOVER/TRANSFER for blood transfusion.
Management
If suspected ectopic pregnancy
 Give IV FLUIDS.
 HANDOVER/TRANSFER for blood transfusion and obstetrical care.

If suspected postpartum haemorrhage

 Give OXYTOCIN
 Give IV FLUIDS
 Plan for HANDOVER/TRANSFER to facility with obstetric care
©WHO/Laerdal Medical
 Perform UTERINE MASSAGE until uterus is hard
 COLLECT placenta for inspection by advanced provider
 Check for perineal and vaginal tears and APPLY DIRECT PRESSURE.
Management
If suspected tension pneumothorax
 Perform rapid NEEDLE DECOMPRESSION.
 Give OXYGEN.
 Give IV FLUIDS.
 Prepare for rapid HANDOVER/TRANSFER to a centre
that can place a chest tube.
©WHO/Laerdal Medical

If suspected pericardial tamponade

 Give IV FLUIDS to help fill the heart.
 Prepare for rapid HANDOVER/TRANSFER to a centre
that can drain the pericardial fluid.
Management
If suspected heart attack
 Give ASPIRIN if indicated.
 Give IV FLUIDS, reassess frequently.
 Give OXYGEN initially.
 Plan for rapid HANDOVER/TRANSFER.
©WHO/Laerdal Medical

If suspected heart failure

 Give IV FLUIDS slowly, check lungs for crackles .
 Stop IV fluids if overload develops.
• DIB, crackles, increased respiratory rate, increased heart rate
 Plan for rapid HANDOVER/TRANSFER.
Management
If suspected severe allergic reaction
 Give intramuscular ADRENALINE.
 Establish IV ACCESS.
 MONITOR closely as adrenaline can wear off .
• You may need a second dose ©WHO/Laerdal Medical

 If airway is swollen or if there is difficulty in breathing, consider

HANDOVER/TRANSFER.

If suspected traumatic injury or blood loss

 Stop the bleeding.
 Give IV FLUIDS.
 Conduct a thorough trauma assessment.
 Plan for rapid HANDOVER/TRANSFER for blood transfusions or surgical care.
Workbook Question 4
Using the workbook section above, list what you would do to manage these
patients:

A 6-year-old boy is brought in with fever. He is in shock and 1.

does not appear malnourished. Your facility has supplies to put 2.
in an IV. 3.
A young man is brought in after a motorcycle crash. He has a 1.
large cut to arm that is bleeding and there is a large pool of 2.
blood under him. He is in shock when you examine him. 3.
A 30-year-old is brought in after accidentally eating prawns. She 1.
has a known shellfish allergy, her body is covered in a red, itchy 2.
rash and she is in shock 3.
Special Paediatric Considerations: Shock
• Shock from dehydration can occur rapidly in children and is
life threatening.
• Children have a relatively large surface area from which to lose fluids.
• Infants and young children are particularly at risk and are unable to
say when they are thirsty and cannot drink more on their own.

• Assessing shock in children:

• Clinical definition based on WHO guidelines: Cold extremities, ©WHO/Laerdal Medical

capillary refill >3 seconds, weak and fast pulse

• Other important signs of poor perfusion include low blood pressure,
fast breathing, altered mental status, decreased urination, signs of
dehydration.
Signs of Dehydration in Children: Danger Signs
• Very dry mouth and lips
• Lethargy (excessive drowsiness, slow to respond, child not
!
interactive)
• Sunken eyes
• Small amounts of dark urine
©WHO/Laerdal Medical

• Sunken fontanelles in infants under 1 year

• Delayed capillary refill (greater than 3 seconds)
• Skin pinch is abnormal
• Pallor (pale skin) ©WHO/Laerdal Medical
Special Paediatric Considerations: Common causes
• Gastroenteritis causes sudden onset of vomiting and diarrhoea with some
abdominal pain and fever.
• Vomiting without diarrhoea may be suggestive of increased pressure on the brain
(trauma or tumor or brain swelling) or intestinal blockage.
• It is important to examine the child for signs of trauma.
• Vomiting associated with fever may suggest infection.

• Overwhelming infection ©WHO/Laerdal Medical

• Fever can make children lose fluids rapidly and become dehydrated quickly.
• Overwhelming infection can make the blood vessels enlarge just as with adults,
making the shock much worse.
Special Paediatric Considerations: Malnutrition

• If shock  give specialized IV FLUIDS if available.

• Malnourished children are at high risk for hypoglycaemia and will
need sugar in addition to fluids.
• Give less IV FLUIDS more slowly and reassess often. ©WHO/Laerdal Medical

• Listen for crackles in the lungs and signs of fluid overload every 5
minutes.
• Stop IV fluids if overload develops.
• Switch to ORAL FLUIDS as soon as signs of poor perfusion improve.
• Prepare for rapid HANDOVER/TRANSFER to an advanced provider.
©WHO/Laerdal Medical
Workbook Question 5
Using the workbook section above, list signs of severe dehydration in children

1.
2.
3.
4.
5.
6.
7.
8.
Disposition of the Patient
• People with shock can worsen or die quickly and must be closely
monitored.
• Illnesses that cause shock can also cause problems with the body’s
ability to manage fluids, monitor closely for DIB.
• Shock patients may be confused or anxious; ensure safety in transport.
• Patients may need HANDOVER/TRANSFER for blood transfusion,
general/obstetric surgery.
• Communicate with receiving facility to ensure these resources are available.
Questions
Quick Cards
Summary
In this presentation, we have covered:
• The signs of shock and poor perfusion
• The SAMPLE history for a patient with shock
• How to perform a secondary exam for a patient with shock
• Assessment of fluid status
• Appropriate fluid administration based on patient’s age, weight and condition
• Recognition of malnourishment, anaemia and burns, and adjust fluid resuscitation
accordingly
• The high-risk causes of shock
• Critical actions to manage patients with shock
• Special paediatric considerations for shock
• Disposition and transport of patients with shock