YEAR 05 • ADVANCED CLINICAL

Anaesthesia & Critical Care

20 learning units • 100 chapter sections • 200 explained questions. Prepare patients for anaesthesia, recognise perioperative emergencies and understand organ support, critical-care teamwork and recovery.

Original RAHBAR study material for the Year 5 learning pathway. Clinical cases support supervised undergraduate learning. Treatment choices, doses and procedures must follow current local protocols and the responsible clinical team. References & further reading ↓

MODULE 11 / 20

Shock & Haemodynamic Support

Recognise impaired tissue perfusion and connect support to the underlying mechanism.

Quick revision ↓ Medical Dictionary

01Recognise poor perfusion

Shock is inadequate tissue perfusion and may precede marked hypotension. Assess mental state, skin, capillary refill, urine output and lactate alongside blood pressure. Trends and context matter: a single normal value cannot establish adequate perfusion in a deteriorating patient.

02Identify the mechanism

Hypovolaemic, distributive, cardiogenic and obstructive mechanisms require different treatment, and mixed shock is common. History, examination, ECG and skilled bedside ultrasound can help identify bleeding, infection, pump failure or obstruction while immediate support continues.

03Test and reassess

Fluid administration should answer a clinical question and be followed by reassessment of perfusion and congestion. Fluid responsiveness does not prove that more fluid is needed or safe. Worsening respiratory findings or absent benefit should prompt review of the working diagnosis and plan.

04Vasoactive support

Vasopressors and inotropes require experienced prescription, reliable delivery and close monitoring. Vasopressors primarily support vascular tone, while inotropes support contractility. Their use does not remove the need to correct haemorrhage, infection, obstruction or another underlying cause.

05Follow the whole patient

Set individual targets and review organ function, lactate trajectory, fluid balance and adverse effects. Persistent shock requires early senior and critical-care input. Document the suspected mechanism, response to each intervention and next decision rather than reporting blood pressure alone.

High-Yield Revision

Shock can occur before profound hypotension.
Mixed mechanisms are common.
Reassess benefit and congestion after fluid.

Common Pitfalls

Treating every low blood pressure with repeated fluid.
Using one lactate value as the entire assessment.

References & Further Reading

Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.

Reference review: 29 September 2026. Consult current local protocols for prescribing, procedures and escalation.