Midwifery (RM)
Management of Shock: Immediate Management
Immediate shock management is an emergency response to inadequate tissue perfusion from haemorrhage, sepsis, hypertensive disease, trauma, or another cause. It prioritizes rapid recognition, ABC resuscitation, oxygenation, circulation support, cause control, and escalation.
Purpose
- Preserve airway, breathing, circulation, and organ perfusion
- Identify and treat the cause rapidly
- Prevent deterioration and death
Indications
- Collapse, altered consciousness, pallor, cold clammy skin, tachycardia, hypotension, oliguria, respiratory distress, or suspected severe illness
- Haemorrhage, sepsis, trauma, anaphylaxis, or obstetric emergency with poor perfusion
Equipment
- Emergency call and resuscitation trolley
- Airway, oxygen, suction, and ventilation equipment
- Two large-bore IV cannulas, fluids, blood-sampling and transfusion supplies
- Monitoring, glucose, urinary catheter, warming, and PPE supplies
- Referral and documentation materials
Preparation
- Know the local shock and massive-haemorrhage pathway and check emergency equipment.
- Ensure referral transport and blood services can be activated.
Procedure steps
- Recognize shock, call for help, assign roles, note time, and assess airway, breathing, circulation, disability, and exposure.
- Position safely, provide high-concentration oxygen as indicated, keep warm, and monitor continuously.
- Establish large-bore IV access, take urgent blood samples, check glucose, and begin prescribed fluid or blood resuscitation.
- Control external bleeding and identify likely cause without delaying resuscitation.
- Monitor vital signs, mental state, oxygen saturation, urine output, perfusion, and response.
- Prepare emergency medicines and definitive treatment according to cause and authorized orders.
- Communicate with obstetric, anaesthetic, neonatal, surgical, laboratory, blood-bank, and referral teams.
- Reassess after every intervention and escalate if response is inadequate.
- Provide concise handover during transfer.
- Document times, findings, interventions, fluids, blood, medicines, response, communication, and transfer.
Precautions
- Do not leave the woman alone or delay resuscitation for paperwork.
- Use warmed fluids and prevent hypothermia where possible.
- Avoid excessive fluids in conditions where overload is a risk and follow senior guidance.
- Use standard precautions and medication checks.
Aftercare
- Continue monitoring during definitive treatment and transfer.
- Provide emotional support and update family within confidentiality limits.
Nursing considerations
- Use closed-loop communication and trend response.
- Treat the cause while maintaining resuscitation priorities.
Patient education
- Explain that urgent treatment is needed and what the team is doing when the woman is able to understand.
- Provide follow-up explanation after stabilization.
Documentation
- Record recognition time, ABC findings, observations, interventions, doses, fluids, blood, urine, response, communication, and transfer.
- Complete emergency and incident records.
References and further reading
Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.
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