• Emergency room or intensive or coronary care unit
• Continuous electrocardiographic monitoring with frequent assessment of blood pressure, respiratory status, and urine output

• Therapy must proceed quickly before extensive damage to vital organs occurs. Therapy is directed simultaneously to correct both the deficit in tissue perfusion and the underlying disease causing shock (see Associated conditions).
• Maintain SaO2 > 95% with supplemental oxygen. Intubate and mechanically ventilate patient if patient cannot be oxygenated with 100% oxygen or has markedly increased breathing effort (excessive oxygen cost of breathing).
• Maintain pH above 7.3 (but less than 7.5) to preserve vascular responsiveness to endogenous or exogenous catecholamines.
• Correct plasma volume deficits rapidly by volume expanders consisting of isotonic saline (0.9% Ns or Ringer's lactate) with or without colloid (albumin 5% or hydroxyethyl starch 6%).
• Packed red blood cell transfusion to correct or prevent anemia. Hgb maintained at or above 10 grams/dL.
• Administer coagulation factors (fresh frozen plasma, cryoprecipitate) and platelets if coagulopathy (prolonged PT, PTT, or platelet count < 50,000) is present in a patient who is bleeding.
• Tachyarrhythmias (other than sinus tachycardia) should be promptly corrected by electrocardioversion. Transvenous pacemakers should be placed to correct bradyrhythmias.
• Vasopressors (see Medications) to correct hypotension or low cardiac output due to myocardial failure or hypotension due to low vascular resistance.
• End points of resuscitation: adequate blood pressure (> 60 mm Hg [8.0 kPa] mean or > 90 mm Hg [12.0 kPa] systolic or within 40 mm Hg [5.32 kPa] of patient's normal blood pressure). Patient is awake/alert, urine output adequate, heart rate < 100, warm skin with brisk capillary refill, bowel sounds present. Lactate < 2 mmol/L, mixed venous PO2 > 30 mm Hg.

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