Hypotension and shock

Shock is a life-threatening physiological state but unfortunately, the identification and treatment of shock are fraught with many difficulties and potential pitfalls. Resources in the out-of-hospital environment limit patient assessment, diagnostic testing, and therapeutic options. Even when shock is properly identified, the most appropriate management is often unknown. Shock states are often categorized by etiology. This approach helps out-of-hospital care providers and EMS physicians organize their assessments and treatment options. Intravenous administration of fluids has been the traditional gold standard of treatment of most critically ill and injured patients. Intraosseous administration is now an option for patients in extremis or cases in which peripheral access is not immediately available. However, controversy still exists over the volume and type of resuscitation fluid. The role of biomarkers and portable diagnostic equipment, such as ultrasound, for the diagnosis and treatment of shock has yet to be determined.