Over 1 million cases of shock present to the emergency department (ED) each year; the presentation may be cryptic or obvious as in the ultimate shock state of cardiac arrest. The definition and treatment of shock continue to evolve because of new understanding and technologies, some of which are now available for ED use. With a contemporary understanding of shock, the emergency physician can initiate expert and timely intervention. Regardless of the specific precipitating events, modifying circumstances, and variable presentations, common principles apply concerning the general approach to a patient in the initial stages of shock.

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