If BP unrecordable, call the cardiac arrest team.
Specific measures:
Anaphylaxis: refer to later blog entry
Cardiogenic shock: refer to later blog entry
Septic shock: (if no clue to source): IV cefuroxime 1.5g/6-8h (after blood culture) or gentamicin, do levels; reduce in renal failure) + antipseudomonal penicillin, eg ticarcillin (as Timentin, max dose 3.2g/4h IVI). Give colloid, or crystalloid, by IVI. Refer to ITU if possible for monitoring inotropes; aim for CVP 8-12mmHg, MAP >65mmHg. Urine >35ml/h. Low dose steroids may help as may recombinant human activated Protein C.
Hypovolaemic shock: Fluid replacement: saline or colloid initially; if bleeding use blood; Titrate against BP, CVP, urine output. Treat the underlying cause. If severe haemorrhage, exsanguinating, or more than 1L of fluid required to maintain BP, consider using group-specific blood. Correct electrolyte abnormalities. Acidosis often responds to fluid replacement.
Heat exposure (heat exhaustion): tepid sponging + fanning; avoid ice and immersion. Resuscitate with high-sodium IVI, such as 0.9% saline ± hydrocortisone 100mg IV. Dantrolene seems ineffective. Chlorpromazine 25mg IM may be used to stop shivering. Stop cooling when core temperature <39°C.
