Editing Shock (circulatory) (section)

===Fluids===
Aggressive intravenous fluids are recommended in most types of shock (e.g. 1–2 liter [[normal saline]] bolus over 10 minutes or 20&nbsp;mL/kg in a child) which is usually instituted as the person is being further evaluated.<ref>{{Cite book |last=American College of Surgeons |title=ATLS, Advanced Trauma Life Support Program for Doctors |publisher=[[American College of Surgeons|Amer College of Surgeons]] |year=2008 |isbn=978-1-880696-31-6 |page=58}}</ref> [[Colloids]] and [[Crystalloid fluid|crystalloids]] appear to be equally effective with respect to outcomes.,<ref name="Lew2018">{{Cite journal |vauthors=Lewis SR, Pritchard MW, Evans DJ, Butler AR, Alderson P, Smith AF, Roberts I |date=August 2018 |title=Colloids versus crystalloids for fluid resuscitation in critically ill people |journal=The Cochrane Database of Systematic Reviews |volume=8 |issue=8 |pages=CD000567 |doi=10.1002/14651858.CD000567.pub7 |pmc=6513027 |pmid=30073665}}</ref> Balanced crystalloids and normal saline also appear to be equally effective in critically ill patients.<ref>{{Cite journal |last1=Liu |first1=C |last2=Lu |first2=G |last3=Wang |first3=D |last4=Lei |first4=Y |last5=Mao |first5=Z |last6=Hu |first6=P |last7=Hu |first7=J |last8=Liu |first8=R |last9=Han |first9=D |last10=Zhou |first10=F |date=November 2019 |title=Balanced crystalloids versus normal saline for fluid resuscitation in critically ill patients: A systematic review and meta-analysis with trial sequential analysis. |journal=The American Journal of Emergency Medicine |volume=37 |issue=11 |pages=2072–78 |doi=10.1016/j.ajem.2019.02.045 |pmid=30852043 |doi-access=free}}</ref> If the person remains in shock after initial resuscitation, [[packed red blood cells]] should be administered to keep the [[hemoglobin]] greater than 100&nbsp;g/L.<ref name=Tint10/>

For those with hemorrhagic shock, the current evidence supports limiting the use of fluids for penetrating thorax and abdominal injuries allowing mild [[hypotension]] to persist (known as [[permissive hypotension]]).<ref name="Rosen2010">{{Cite book |last=Marx |first=J |title=Rosen's emergency medicine: concepts and clinical practice 7th edition |publisher=Mosby/Elsevier |year=2010 |isbn=978-0-323-05472-0 |location=Philadelphia, PA |page=2467}}</ref> Targets include a [[mean arterial pressure]] of 60&nbsp;mmHg, a [[systolic blood pressure]] of 70–90&nbsp;mmHg,<ref name=Tint10/><ref name=EMB11/> or until the patient has adequate [[mentation]] and peripheral pulses.<ref name="EMB11">{{Cite journal |last=Cherkas |first=David |date=Nov 2011 |title=Traumatic Hemorrhagic Shock: Advances In Fluid Management |url=http://www.ebmedicine.net/store.php?paction=showProduct&catid=8&pid=244 |url-status=dead |journal=Emergency Medicine Practice |volume=13 |issue=11 |pages=1–19; quiz 19–20 |pmid=22164397 |archive-url=https://web.archive.org/web/20120118152838/http://www.ebmedicine.net/store.php?paction=showProduct&catid=8&pid=244 |archive-date=2012-01-18}}</ref> [[Tonicity#Hypertonic solution|Hypertonic fluid]] may also be an option in this group.<ref>{{Cite journal |vauthors=Wu MC, Liao TY, Lee EM, Chen YS, Hsu WT, Lee MG, Tsou PY, Chen SC, Lee CC |date=November 2017 |title=Administration of Hypertonic Solutions for Hemorrhagic Shock: A Systematic Review and Meta-analysis of Clinical Trials |journal=Anesthesia and Analgesia |volume=125 |issue=5 |pages=1549–57 |doi=10.1213/ANE.0000000000002451 |pmid=28930937 |s2cid=39310937}}</ref>