Ashok Kumar Pannu

Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Keywords: Adults, anaphylactic, cardiogenic, circulatory, management, point‑of‑care ultrasound, resuscitation, septic, shock, vasopressor


Circulatory shock is a common condition that carries high morbidity and mortality. This review aims to update the critical steps in managing common types of shock in adult patients admitted to medical emergency and intensive care units. A literature review was performed by searching PubMed, EMBASE Ovid, and Cochrane Library, using the following search items: (“shock” OR “circulatory shock” OR “septic shock” OR “cardiogenic shock”) AND (“management” OR “treatment” OR “resuscitation”). The review emphasizes prompt shock identification with tissue hypoperfusion, knowledge of the underlying pathophysiological mechanism, initial fluid resuscitation with balanced crystalloids, norepinephrine as the preferred vasopressor in septic and profound cardiogenic shock, and tailored intervention addressing specific etiologies. Point of care ultrasound may help evaluate an undifferentiated shock and determine fluid responsiveness. The approach to septic shock is improving; however, confirmatory studies are required for many existing (e.g., amount of initial fluids and steroids) and emerging (e.g., angiotensin II) therapies. Knowledge gaps and wide variations persist in managing cardiogenic shock that needs urgent addressing to improve outcomes.

How to cite this article: Pannu AK. Circulatory shock in adults in emergency department. Turk J Emerg Med 2023;23:139-48.

Author Contributions

AKP: Conceptualization; Literature search; Writing‑original draft, review and editing. The corresponding author is responsible for ensuring that the descriptions are accurate and agreed upon by all authors.

Conflict of Interest

None declared.

Financial Disclosure

None declared.


The author (AKP) is grateful to Mrs. Sunaina Verma for her timely intellectual assistance.