Monitoring

The capability for monitoring a patient in shock for response to fluid therapy is deemed essential at all hospital levels. This includes an understanding of the stages of haemorrhagic shock. It also includes the following basic equipment: clock or watch with second hand, stethoscope, blood pressure cuff and urinary catheter with collection bag (or improvised equivalent). The following monitoring devices add utility, but also cost, and hence are deemed desirable, depending on the hospital level (see table): electronic cardiac monitoring, monitoring of central venous pressure and right-heart catheterization with monitoring of pulmonary capillary wedge pressure.

Laboratory tests assist in the assessment of the presence of shock, the degree of bleeding and response to resuscitation. Haematocrit or haemoglobin monitoring is deemed essential at all hospital levels. Measurements of electrolytes (sodium, potassium, chloride, bicarbonate), blood urea nitrogen, creatinine, glucose, lactate and arterial blood gases are all considered desirable, depending on the hospital level. All of these add considerable utility to the management of a patient in shock. However, they also add considerable cost and hence cannot be considered essential.

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