Red flags
- MAP <65, lactate >4, cool peripheries, oliguria
- Altered mental status
First steps
- ABCDE, 2 large-bore IV, urgent labs incl. lactate, type & crossmatch
Key investigations
- Lactate, ABG, CBC, RFT, coags
- ECG, troponin, BNP
- Bedside echo + IVC, POCUS abdomen
Differentials
- Hypovolemic
- Cardiogenic
- Distributive (septic, anaphylactic, neurogenic)
- Obstructive (PE, tamponade, tension PTX)
Initial management
- Crystalloid 30 ml/kg unless cardiogenic/obstructive
- Vasopressor: noradrenaline first-line for distributive
- Treat underlying: antibiotics, blood, pericardiocentesis, thrombolysis
Referral
- ICU admission
- Surgery / Cath lab as indicated
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