Hypotension and shock
Recognising shock before the BP falls, sorting it into hypovolaemic, distributive, cardiogenic and obstructive with bedside haemodynamics and ultrasound, and the first-hour management of each type, including Surviving Sepsis 2026.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Shock is hypoperfusion, not a number. Tachycardia, confusion, oliguria, mottling and a rising lactate come before hypotension, especially in young patients and those on beta-blockers.
- Four mechanisms: hypovolaemic, distributive, cardiogenic and obstructive. Patients often have more than one.
- The first look decides the first hour: warm or cold, wet or dry, JVP up or down. Point-of-care ultrasound confirms it.
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Sources
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026Society of Critical Care Medicine and European Society of Intensive Care Medicine, 2026
- Sepsis Clinical Care StandardAU/NZAustralian Commission on Safety and Quality in Health Care, 2022
- Therapeutic Guidelines: Cardiovascular (eTG complete)AU/NZTherapeutic Guidelines Limited, topic version not verified
- Patient Blood Management Guideline for Adults with Critical BleedingAU/NZNational Blood Authority, 2023, updated 2025
- Microaxial flow pump or standard care in infarct-related cardiogenic shock (DanGer Shock)New England Journal of Medicine (Møller et al.), 2024
- Hydrocortisone in patients with septic shock (ADRENAL)New England Journal of Medicine (Venkatesh et al.), 2018
- A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on hemodynamic managementGlobal Spine Journal (Kwon et al., AO Spine/Praxis), 2024
- Personalized hemodynamic resuscitation targeting capillary refill time in early septic shock (ANDROMEDA-SHOCK-2)JAMA (ANDROMEDA-SHOCK-2 Investigators), 2025
- Guideline 11.10: Resuscitation in special circumstancesAU/NZAustralian and New Zealand Committee on Resuscitation, 2026
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback