Key messages

• An initial insult results in a primary disease process which can lead to a multisystem disturbance (the systemic inflammatory response syndrome) secondary to inflammatory mediators released during shock.

• A history and examination should initiate the search for the cause of the systemic inflammatory response syndrome.

• Regional assessment includes investigation of the cardiovascular, respiratory, renal, gastrointestinal, hematological, and metabolic systems. Suspected infection should be investigated.

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