The clinical manifestations of different types of shock are similar, and comprehensive therapeutic measures should be taken to address the causes of shock and the hemodynamic changes in different stages of shock development, the fundamental purpose of treatment is to restore effective tissue perfusion. 1, hypovolemic shock hypovolemic shock in the emergency department is more common, mainly refers to hemorrhage or fluid loss caused by a sudden decrease in circulating blood volume of shock, timely replenishment of blood volume, treatment of the original disease and stop continued blood loss, fluid loss is the key to the treatment of this type of shock. The most important diagnosis of hypovolemic shock is about the diagnosis of internal bleeding. Patients often have a history of trauma or surgery, chest auscultation and percussion as well as abdominal percussion and mobile turbid sound examination can easily make the diagnosis of thoracic and abdominal effusion, and diagnostic puncture of thoracic and abdominal cavity with non-coagulated blood can clarify the diagnosis, and abdominal ultrasonography and diagnostic abdominal lavage can be performed if necessary. Spinal and pelvic fractures can result in massive retroperitoneal bleeding, and in femur fractures large amounts of blood can collect in the soft tissues of the thigh, which may be overlooked in the diagnosis and should be given special attention. In addition to the general principles of shock treatment that must be followed, the main focus is to tailor the treatment to the cause of blood loss. For traumatic external bleeding, temporary hemostasis such as compression, bandage, tourniquet should be applied promptly according to the bleeding artery, and early formal debridement as well as surgical hemostasis is advocated when available. For shock caused by internal bleeding, emergency surgery should be performed while actively expanding the volume and preparing blood transfusion, but the method of surgery should be as simple as possible, and its main purpose is to stop the bleeding. If the blood pressure returns to normal and can be maintained, it indicates that the blood loss is small and the bleeding is no longer continuing, and if the patient’s hematocrit is >30%, the above solution can be continued without blood transfusion. If the blood loss is large or continues, blood transfusion should be given if the above treatment is difficult to maintain the circulating blood volume. For patients with uncontrolled hemorrhagic shock, massive and rapid fluid resuscitation may accelerate blood loss, causing dilutive coagulation dysfunction and metabolic acidosis due to reduced tissue oxygen supply, and the input of large amounts of fluid affects the vasoconstriction response, dislodging the already formed blood clots and aggravating bleeding, so restrictive low-pressure resuscitation is better than active positive pressure resuscitation, with systolic pressure maintained at 90~100 mmHg is sufficient. For patients in shock with active bleeding, it is not recommended to give large amounts of fluids quickly for “immediate” resuscitation, but to perform definitive surgery early to stop bleeding completely before “delayed” fluid resuscitation. There is no uniform understanding of the type of resuscitation fluid, whether to infuse crystalloid or colloid fluid, and whether to choose isotonic or hypertonic solution in crystalloid. 2, cardiogenic shock cardiogenic shock is due to a variety of acute cardiac lesions caused by cardiac pumping dysfunction, cardiac output is sharply reduced, resulting in hypotension, peripheral circulation and tissue hypoperfusion, increased left ventricular filling pressure as the main characteristics of the clinical syndrome. Cardiogenic shock is most often seen in acute left ventricular myocardial infarction, where clinical signs of shock occur when 40% of the left ventricular myocardium loses contractile function. For patients with cardiogenic shock after acute myocardial infarction, limiting the area of myocardial infarction and enabling reperfusion of ischemic myocardium (PCI or thrombolytic therapy) is the key to successful treatment of cardiogenic shock. For right ventricular infarction combined with hypotension, appropriate dilation is given first, and then the application of the positive inotropic drug dobutamine is considered), and if drug therapy is ineffective, intra-aortic balloon counterpulsation support can be considered. 3.Distributive shock is due to various factors leading to vasodilatory dysfunction, blood flow distribution abnormalities, and cause insufficient tissue perfusion, when the blood volume is relatively insufficient, and not absolutely reduced. It mainly includes infectious shock and anaphylactic shock. (1) Infectious shock: Infectious shock is closely related to multi-organ insufficiency and acute respiratory distress syndrome, and its pathophysiological changes are complex and treatment is difficult. (1) Control of infection:The main measures are the application of antibiotics and treatment of the primary foci of infection. Emergency treatment should be given within 3 hours as far as possible, blood samples should be taken for blood culture before applying antibiotics, and strong and broad-spectrum antibiotics are advocated for infections with unknown pathogens, with a heavy hand to comprehensively cover possible pathogenic bacteria, control the source of infection and prevent continued or other pathogenic invasion, and narrow-spectrum antibiotics with strong targeting should be used as early as possible for those with clear pathogens. Early treatment of the primary infected lesion, if surgery is needed, try to take the surgery with less damage and shorter time. After the application of antibiotics in acute severe infections need to be observed for 48~72 hours, and then decide whether to switch antibiotics according to the efficacy. (2) supplemental blood volume: once diagnosed with infectious shock, active fluid resuscitation should be carried out as soon as possible, firstly, 20ml/kg crystalloid should be given to expand blood volume, and the goal of resuscitation should be achieved within 6 hours: mean arterial pressure (MAP) maintained at ≥65mmHg, central venous pressure (CVP) reaching 8~12cmH2O, central venous or mixed venous oxygen saturation ≥70% (2) Anaphylactic shock: maintain the AP at ≥65mmHg, central venous pressure (CVP) at 8~12cmH2O, central or mixed venous oxygen saturation at ≥70%, urine volume at 0.5ml/(kg-h), hemoglobin at 100/L, hematocrit at 30%~35% if necessary, supplemented with appropriate albumin, plasma or whole blood to restore sufficient effective circulating blood volume. (2) Anaphylaxis: Anaphylaxis often occurs suddenly after the application of some drugs or contact with allergenic protein-like substances, due to the effect of allergens that sensitize the body to produce antibodies (gE), adsorbed on basophils and mast cells located around the blood vessels in the circulating blood, so that after sensitization and then contact with specific antigens, the release of pharmacologically active substances such as histamine, bradykinin or slow-reacting substances, and so on. Allergic syndrome is produced. Thorough prevention and prevention of anaphylaxis is the best treatment. For patients at risk of anaphylaxis, pen injections or intradermal sensitivity tests should be performed at the distal end of the limb, with epinephrine, diphenhydramine, oxygen and a tourniquet always available. In the event of anaphylaxis, a tourniquet should be immediately tied around the proximal end of the injection site, and if necessary, the injection site should be incised and flushed to aspirate as much of the injected solution as possible. In case of anaphylactic shock, the patient should be resuscitated in situ, and epinephrine 0.5~1mg can be injected subcutaneously immediately, or intravenously if necessary, and if the symptoms are not relieved, it can be repeated once in 30 minutes. Apply antihistamines and intravenous glucocorticoids at the same time. If the patient occurs respiratory cardiac arrest, cardiopulmonary resuscitation should be performed immediately on the spot. 4, obstructive shock obstructive shock is mostly caused by tension pneumothorax, massive pericardial effusion cardiac compression, constrictive pericarditis, acute pulmonary embolism, aortic coarctation, left atrial mucus aneurysm, etc., when the blood volume is not reduced, but the ventricular ejection is blocked or blood is stagnant in the aorta, resulting in peripheral circulatory dysfunction. The treatment of obstructive shock should mainly be directed at the original disease, such as tensor pneumothorax patients promptly puncture and deflate or perform closed drainage of the chest cavity to reduce the pressure in the pleural cavity, after closed drainage, generally small lung fissures can be closed within 3-7 days, to stop the air leakage for 24 hours, the lung has been confirmed by X-ray examination, the party can be extubated; a large number of pericardial effusion cardiac compression patients for pericardial puncture and fluid extraction Patients with acute pulmonary artery embolism should be given anticoagulation or thrombolytic therapy according to hemodynamic changes, and local thrombolysis by interventional surgery if necessary; patients with aortic coarctation should have strict control of blood pressure, and it is generally recommended to apply sodium nitroprusside to control systolic blood pressure at 100-110 mmHg, and apply β-blockers to lower heart rate and reduce myocardial contractility, etc., and Actively contact surgery for surgical treatment.