Table 2 The MINUTES acronym to guide the initial management of undifferentiated shock
Letters of the acronym | Description of the item | Objectives |
|---|---|---|
Maintain “ABCs” | Provide basic and advanced life support (e.g., compress external bleeding, decompress tension pneumothorax) | Control rapidly lethal etiologies. |
INfuse vasopressors and/or fluids | Reverse life-threatening arterial hypotension using vasopressors and/or rapid fluid bolus according to the clinical scenario and gestalt. | Achieve MAP ≥ 65 mmHg as soon as possible |
INvestigate main causes | Perform ECG, blood gas analysis, and send cardiac enzymes. | Conduct essential and simple tests to identify the underlying etiology. |
Ultrasound | Conduct cardiac ultrasound to identify the type of shock. Conduct lung ultrasound to identify congestion and pneumothorax. | Use point-of-care ultrasound to identify the shock type. |
Treat underlying Etiology | Specific therapy of the underlying etiology of shock (e.g., thrombolysis for pulmonary embolism, drainage of pericardial tamponade, revascularization of coronary occlusion, control of the infectious source). | Reversal of the underlying pathology causing shock. |
Stabilize systemic organ perfusion | Evaluate (e.g., urine output, liver function, electrolytes) and stabilize systemic organ perfusion. | Optimize systemic organ perfusion and avoid fluid overload. |