Shock.

Inevitably, a patient in shock will present to your office. The findings may be obvious, or they may show the more subtle changes of mild tachypnea, tachycardia, and/or changes in mental status. In either event, the perfusion pressure either has already decompensated or will do so momentarily. Whether you initiate therapy then and there might well determine whether your patient will survive. Accordingly, each office should have available for the pre-hospital management of shock those items listed in Table 3. As clinicians, you must be prepared to begin treatment in your office. Although the hospital, particularly the intensive or coronary care unit, is the appropriate setting for the management of shock, therapy must be initiated as soon as and wherever the diagnosis is made. In this situation, an ounce of prevention is indeed worth a pound of cure. Shock, whether it develops insidiously or precipitously, is a state of inadequate tissue perfusion that, if misdiagnosed or treated inadequately, will inevitably result in death.