When should I consider referring a patient with suspected shock to sec

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

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 .
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 .
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 .
For suspected cardiogenic shock or acute coronary syndrome presenting with chest pain and haemodynamic instability, urgent referral to hospital is required without delay .

Information to provide to the receiving team:

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

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