ACCS General Critical Care Practice Exam

Restoring circulating volume with intravenous fluids is the first step in shock management. Shock leads to inadequate tissue perfusion, and the quickest way to improve perfusion is to increase the intravascular volume so the heart can pump more effectively. Start with isotonic crystalloids (such as normal saline or lactated Ringer’s), giving a bolus and reassessing response. A typical initial approach is about 20–30 mL/kg, repeated as needed, guided by blood pressure, urine output, mental status, and signs of perfusion. If perfusion remains uncertain after adequate fluid administration, vasopressors are added to maintain target blood pressure while continuing fluid resuscitation. Blood transfusion is not the initial step unless there is ongoing hemorrhage or severe anemia. Observation alone would not address the urgent perfusion deficit in shock.