First Things First (assess and treat for the following)

• Always attend to ABCs as first priority.
  • Is airway patent?
  • Can pt maintain his/her current work of breathing (is intubation required)?
  • Is pt hypotensive?
  • Does pt have evidence of hypoperfusion?
  • Does pt have evidence of hypovolemia, hypervolemia or diminished cardiac output?
• Acid-base disorders commonly occur in response to underresuscitated shock states.
  • Hypotension is a late finding in shock.
  • Assess for other evidence of end-organ hypoperfusion.
• Complex acid-base disorder calculations should be straightforward if you adopt a consistent stepwise approach (see “General Management Principles” section).