When should I consider referring a patient with suspected shock to secondary care, and what information should I provide to the receiving team?

When to consider referring a patient with suspected shock to secondary care:

• Refer immediately if the patient meets any high-risk criteria for severe illness or death from sepsis, such as new altered mental state, systolic blood pressure ≤90 mmHg, raised respiratory rate ≥25 breaths per minute, heart rate >130 beats per minute, or signs of poor perfusion like mottled or cyanotic skin ¹.
• Consider referral if the patient has moderate to high risk criteria combined with impaired immunity or acute deterioration, including systolic blood pressure 91-100 mmHg, respiratory rate 21-24 breaths per minute, or reduced urine output ¹.
• In cases of suspected shock due to trauma or major injury, urgent transfer to a major trauma centre or appropriate secondary care facility is indicated, especially if airway, breathing, or circulation is compromised ⁴.
• For suspected cardiogenic shock or acute coronary syndrome presenting with chest pain and haemodynamic instability, urgent referral to hospital is required without delay ³.

Information to provide to the receiving team:

• Clinical observations including Glasgow Coma Scale (GCS) scores with detailed components (eye, verbal, motor) ².
• Vital signs: blood pressure, heart rate, respiratory rate, oxygen saturation, temperature, and urine output ¹.
• Details of any interventions already initiated, such as oxygen therapy, intravenous fluids, or medications administered ¹,³,⁴.
• Relevant history including onset and progression of symptoms, comorbidities, immunosuppression status, and any recent trauma or surgery ¹,⁴.
• Results of any investigations performed, such as ECG findings in suspected cardiac cases, or imaging if available ³,⁴.
• Mode of transport and whether the patient is accompanied by a competent adult, and if ambulance transfer is required based on clinical condition ².
• Inform the destination hospital by phone of the impending transfer and provide a written summary of signs, symptoms, and clinical findings ².