Shocked patient - sepsis‑focused guidance
Definition and approach
Shock is circulatory failure causing inadequate tissue perfusion, cellular hypoxia and organ dysfunction.
In the emergency department the priorities are rapid recognition, immediate resuscitation to restore perfusion and oxygen delivery, identification of the dominant mechanism (distributive, hypovolaemic, cardiogenic or obstructive) and early definitive management including source control and escalation to critical care.
National guidance (NICE NG253/NG254, RCEM, Resuscitation Council UK, NICE NG39) defines time‑sensitive targets and practical resuscitation steps that should be followed.
Mechanisms and common causes Shock results from one or more of the following mechanisms:
- Loss of circulating volume (hypovolaemic): haemorrhage, gastrointestinal losses, burns, osmotic diuresis.
- Inadequate vascular tone with maldistribution (distributive): sepsis, anaphylaxis, neurogenic shock.
- Pump failure (cardiogenic): myocardial infarction, arrhythmia, myocarditis, valve failure.
- Mechanical obstruction to filling or outflow (obstructive): tension pneumothorax, cardiac tamponade, massive pulmonary embolism.
Recognition and early assessment
- Suspect shock with hypotension, tachycardia, altered mental state, oliguria, delayed capillary refill or cool peripheries. Note that early septic distributive shock may be warm and bounding.
- Use a structured early warning score (NEWS2 for adults; age‑appropriate paediatric tools) and routinely ask “Could this be sepsis?” in unwell patients or those with suspected infection (NICE NG253/NG254).