Table 3: Summary of Shock Treatments.

Treatment goal	Management
Correct mechanical problem (e.g. tamponade, surgical bleeding)	Immediate surgical correction
Optimise preload	Start with crystalloid infusion 5–10 ml/kg and continue up to 20 ml/kg Continue with colloid infusion up to 20ml/kg (gelatine if GFR > 35 ml/min or albumin 5 % if GFR < 35 ml/min)
Optimise vascular tone and perfusion pressure	NA infusion 0.1-1 µg/kg/min Vasopressin infusion 0.01-0.04 U/min if NA ≥0.5 µg/kg/min Consider methylene blue 1 x 2 mg/kg iv if < 24 hours after cardiac surgery and if NA ≥0.5 µg/kg/min
Optimise myocardial contractility	Dobutamine infusion up to 5 µg/kg/min Milrinone infusion 0.01–0.25 µg/kg/min (particularly useful in patients under β-blockers) Adrenaline infusion up to 0.3 µg/kg/min infusion in case of life-threatening shock. Consider ECLS in non-responders to pharmacological inotropic support
Optimise heart rate and rhythm:- Bradycardia – Atrial fibrillation, VES, ventricular tachycardia	Consider external/internal pacing Optimise magnesium and potassium levels Amiodaron 2x 150 mg over 30min iv, followed by an infusion of 600-1200 mg/d (total of 0.1g/kg) Synchronised electrical cardioversion (biphasic 2x200 joule)
Optimise oxygen delivery	Deliver oxygen via face-mask (goal SaO2 92-98 %) Early intubation and mechanical ventilation to reduce oxygen expenditure Haematocrit goal ≥27 % in the acute shock phase
Sepsis/SIRS	SIRS: Hydrocortisone 100 mg loading dose iv, followed by 50 mg qid iv for 5 days, when NA ≥0.3 µg/kg/min Sepsis: Begin empiric antibiotic therapy within one hour after suspicion of septic shock (after sampling for microbiology)

CVVHD = continuous veno-venous haemodiafiltration; ECLS = extracorporeal life support; NA = noradrenalin; qid quarter in die (for times a day); SaO₂ = oxygen saturation; SIRS = systemic inflammatory response syndrome; VES = ventricular extra-systolies.