ABSTRACT
In general, the management of any patient follows the familiar pattern of history, examination, investigations and finally treatment. This process takes time, and therefore a different approach is needed for the critically ill patient, for whom treatment is so urgent that it must be initiated before the diagnostic process has been fully completed. The most urgent clinical presentation of all is cardiorespiratory arrest. This is a clinical syndrome characterised by the absence of measurable cardiac output or adequate spontaneous respiratory effort. The standard algorithm for the management of cardiac arrest in the United Kingdom is published by the Resuscitation Council. Unless the patient is clearly fluid overloaded, provide an intravenous fluid challenge consisting of 250–500 ml of normal saline or colloid, and assess the response. Ruptured abdominal aortic aneurysm is one situation in which a degree of hypotension should be tolerated in order to prevent disruption of a partially formed thrombus and catastrophic haemorrhage.
