Hypotension and shock

Shock is the failure of the body to meet the metabolic demands of tissues, resulting in hypoperfusion, end-organ injury, and in some cases death. Prehospital management requires the clinician to rapidly identify and correct these deficits in perfusion. The mainstay of prehospital shock management is volume resuscitation, but it may include life-saving interventions to mitigate the causes of shock (e.g., tourniquets, needle thoracostomy) or restore perfusion (e.g., blood administration, vasopressors, or ionotropic agents). These treatments must be delivered without delay, and should take into account the patient's age, comorbid disease, and shock etiology. During protocol development, emergency medical services directors should emphasize immediate treatment when shock is identified and rapid delivery of the patient to definitive care.