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#drabhishekshukla

Dr. Abhishek Shukla explained the critical management of a patient presenting in the emergency at night in an unconscious, drowsy state with a high pulse rate (tachycardia of 170–180/min), low SpO₂, hypotension, and signs of hypoxia. The clinical picture immediately suggests shock, and the first priority in all such cases is to stabilize the patient. This begins with shifting the patient to assisted and controlled ventilation to maintain oxygenation. If there is room to administer fluids, a bolus of 500 ml normal saline is given stat. Continuous monitoring is essential, and if there’s no improvement in blood pressure, inotropic and vasopressor support must be initiated within 30–40 minutes using agents like noradrenaline, dopamine, dobutamine, vasopressin, or adrenaline. Among the possible causes of shock in such patients, cardiogenic shock must be strongly considered, especially when there’s hypotension and signs of poor perfusion. To rule out myocardial infarction or arrhythmias, an ECG should be done immediately, and cardiac biomarkers like Troponin T and NT-proBNP must be sent to assess for cardiac injury and heart failure. Simultaneously, a bedside echocardiography and IVC assessment help in differentiating between cardiogenic and other forms of shock. If the IVC is not collapsed and there are symptoms of fluid overload, it supports cardiogenic shock, and fluid resuscitation should be done cautiously to avoid worsening heart failure. Another important differential is hypovolemic shock, often due to fluid loss or internal bleeding. In this case, if the IVC appears collapsed on ultrasound, it indicates a low intravascular volume, and aggressive fluid replacement of 1.5–2 liters may be warranted. The third possibility is septic shock, where infection triggers systemic inflammation and vasodilation. Here, history taking becomes crucial to look for any source of infection, such as respiratory or urinary. Investigations including urine or sputum culture and Procalcitonin levels guide diagnosis. Once sepsis is suspected, broad-spectrum antibiotics should be administered promptly after culture samples are drawn. Regardless of the cause, Dr. Shukla emphasized that the cornerstone of shock management is timely stabilization, continuous reassessment, and cause-specific interventions initiated without delay. #AasthaCares #EmergencyMedicine #ShockManagement #CardiogenicShock #HypovolemicShock #SepticShock #CriticalCare #ICUProtocols #MedicalEducation #EmergencyCare #InotropicSupport #LifeSavingCare #GeriatricEmergency #EmergencyResponse