Shock

Refractory shock with low Na+ / high K+ / low glucose → give hydrocortisone without waiting for cortisol result

Reversible causes — 4 Hs (Hypoxia, Hypovolaemia, Hyper/hypokalaemia & metabolic, Hypothermia) & 4 Ts (Thrombosis, Tampon

Critical neonatal coarctation presenting as collapse when the duct closes → PROSTAGLANDIN to reopen/maintain the duct +

Cardiogenic or obstructive shock (raised JVP) — aggressive fluids can worsen it → treat the obstruction/pump cause

Hypotension + multi-organ failure → emergency resuscitation/critical care

Young patient, bilateral, sensory loss, or other neurology → suspect MS or a structural lesion (atypical features) → MRI

Active variceal haemorrhage → major haemorrhage protocol; high mortality

Septic shock/Reynolds pentad → emergency resuscitation + urgent biliary decompression

Severe pancreatitis (Glasgow ≥3 / persistent organ failure) → HDU/ITU, high mortality

Type A dissection (ascending aorta) → emergency cardiothoracic surgery

Acute severe AR (aortic dissection or endocarditis) → emergency surgery — poorly tolerated, do not delay

Sepsis/mediastinitis → emergency resuscitation + surgery (high mortality, time-critical)

Neonatal salt-wasting adrenal crisis — hyponatraemia + hyperkalaemia + hypoglycaemia + shock is a medical emergency

Generalised peritonitis with free gas → emergency resuscitation + surgery

Cardiovascular collapse on duct closure → PROSTAGLANDIN immediately + intensive care

Severe/complicated falciparum malaria (cerebral, hypoglycaemia, acidosis, AKI, high parasitaemia) → medical EMERGENCY →

Acute severe MR from papillary muscle rupture (days after an inferior MI) → cardiogenic shock → emergency surgery

Pneumoperitoneum (perforation), shock, abdominal wall erythema → urgent surgery

Pain out of proportion, rapid spread, crepitus, skin necrosis/anaesthesia, or systemic toxicity → immediate surgical ref

Concealed abruption (shock disproportionate to visible blood), fetal distress, DIC, Couvelaire uterus

TENSION pneumothorax (haemodynamic compromise, tracheal deviation) → IMMEDIATE needle/finger decompression then chest dr

Massive PE with haemodynamic instability (hypotension/shock) → thrombolysis (or embolectomy)

OBSTRUCTED + infected kidney (pyonephrosis) — stone/obstruction with infection → EMERGENCY decompression (nephrostomy/st

Lactate >2, systolic BP <90 / MAP <65, reduced GCS, mottling, anuria → escalate to critical care

Acute trauma → immobilise/C-spine; neurogenic shock (hypotension + bradycardia); respiratory compromise if high cervical

S. aureus bacteraemia → always seek a source (echo for endocarditis, MRI spine for discitis) — never dismiss as a contam

STOP the transfusion immediately for any significant reaction and reassess (ABCDE); recheck the patient/unit identity

Pulseless VT or VF → immediate defibrillation + ALS (shockable arm)

First presentation needs imaging to exclude a secondary cause; very high pain/suicidality risk in clusters

Significant/ongoing bleeding → endoscopic therapy