Part 1: Undifferentiated shock

With Dr Rob Hislop Intensive Care Unit consultant, Royal Prince Alfred Hospital and Dr Bruce Way, Emergency Physician and Director of Prevocational Education and Training at Prince of Wales Hospital, New South Wales, Australia

Introduction

Shock is a state where there is inadequate perfusion of tissues. Causes can be broadly categorised into vasodilatory, cardiogenic, hypovolaemic and obstructive shock. These categories and an approach to undifferentiated shock will be explored here.

Case

The scout nurse rings you from theatre on behalf of the surgical registrar who is asking you to review a patient for her on the surgical ward.  The message you get is that the patient has undergone a thoracic biopsy that day which was a minor procedure. She is ‘a bit hypotensive’ and the surgical registrar has asked you to have a look at the patient and chart some fluids.

On review of the patient’s notes she is a 43-year-old lady previously well, being investigated for fluctuating fever and cough, with an outpatient CT chest showing a mediastinal mass.

Your review reveals BP 90/55, HR125 and a patient who seems confused and not aware she is in hospital.

As the cause of hypotension and tachycardia can be varied in this patient your questions, history and examination should aid in determining the causes.