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Prognosis and Treatment

Untreated shock is usually fatal. Even with treatment, mortality from cardiogenicshock after MI (60 to 65! and se"tic shock (#0 to $0! is high. %rognosis

de"ends on the cause, "ree&isting or com"licating illness, time 'etween onset and

diagnosis, and "rom"tness and adeuacy of thera"y.

General management

)irst aid involves kee"ing the "atient warm. E&ternal hemorrhage is controlled,

airway and ventilation are checked, and res"iratory assistance is given if

necessary. *othing is given 'y mouth, and the "atient+s head is turned to one side

to avoid as"iration if emesis occurs.

reatment 'egins simultaneously with evaluation. -u""lemental / 'y face mask

is "rovided. If shock is severe or if ventilation is inadeuate, airway intu'ation

with mechanical ventilation (see irway Esta'lishment and 1ontrol 2 racheal

Intu'ation! is necessary. wo large (3$4 to 364gauge! I catheters are inserted into

se"arate "eri"heral veins. central venous line or an intraosseous needle,

es"ecially in children, "rovides an alternative when "eri"heral veins cannot

 "rom"tly 'e accessed (see also ascular ccess 2 Intraosseous Infusion!.

y"ically, 3 (or /0 m7kg in children! of 0.8 saline is infused over 35 min. Inma9or hemorrhage, :inger+s lactate is commonly used. Unless clinical "arameters

return to normal, the infusion is re"eated. -maller volumes (eg, /50 to 500 m!

are used for "atients with signs of high right4sided "ressure (eg, distention of neck 

veins! or acute MI. fluid challenge should "ro'a'ly not 'e done in a "atient with

signs of "ulmonary edema. )urther fluid thera"y is 'ased on the underlying

condition and may reuire monitoring of 1% or %%. ;edside cardiac

ultrasonogra"hy to assess contractility and vena caval res"iratory varia'ility may

hel" determine the need for additional fluid vs the need for inotro"ic su""ort.

%atients in shock are critically ill and should 'e admitted to an I1U. Monitoring

includes E1

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invasive alternative. -erial measurements of ;