Shock, by definition, is a clinical syndrome that develops due to inadequate tissue perfusion. Hypoperfusion results in insufficient delivery of oxygen and nutrients for metabolism, leading to severe vital organ dysfunction. Untreated or undertreated shock may result in multiple organ failure and death. Patients enter into the shock state due to hypovolemia, trauma, sepsis, cardiac dysfunction, or severe neurologic compromise. The physician's role in patient management is to ensure adequate hemodynamic support first (airway, breathing, circulation), followed by an aggressive search for the etiology of shock. With few exceptions, the first inotrope, the first pressor, should be fluid.
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