The MINUTES bundle was discussed in one of the sessions @ISICEM in Brussels. The MINUTES bundle is a structured approach designed to guide healthcare professionals in the initial 30-minute management of patients presenting with undifferentiated circulatory shock. The acronym stands for Maintain ABCs, INfuse vasopressors and/or fluids, INvestigate, Ultrasound, Treat Etiology, and Stabilise. Each component represents a critical step in the early recognition and intervention process to improve patient outcomes.
1. Maintain ABCs (Minute 0)
The immediate priority upon recognising shock is to ensure the patient's Airway, Breathing, and Circulation (ABCs) are intact. This involves securing airway patency, confirming adequate ventilation, and assessing for the presence of a central pulse. Rapid identification and management of life-threatening conditions, such as external bleeding or tension pneumothorax, are crucial at this stage. Implementing basic and advanced life support measures promptly can be lifesaving.
2. INfuse Vasopressors and/or Fluids (Minutes 0–10)
After stabilising the ABCs, the next step is to restore adequate organ perfusion. This is achieved by administering vasopressors and/or intravenous fluids, tailored to the patient's clinical scenario. The goal is to rapidly achieve a mean arterial pressure (MAP) of at least 65 mmHg to ensure sufficient blood flow to vital organs. The choice between fluids and vasopressors depends on the suspected underlying cause of shock and the patient's volume status.
3. INvestigate (Minutes 5–15)
Concurrent with haemodynamic support, essential investigations should be initiated to identify the aetiology of shock. This includes obtaining blood samples for tests such as arterial blood gas analysis, lactate levels, complete blood count, and renal function tests. Performing an electrocardiogram (ECG) can help detect cardiac ischaemia or arrhythmias. These investigations provide critical information to guide further management decisions.
4. Ultrasound (Minutes 10–20)
Point-of-care ultrasound (POCUS) serves as a non-invasive, rapid diagnostic tool to assess the type and cause of shock. It can help identify conditions like cardiac tamponade, pneumothorax, pulmonary embolism, or severe hypovolaemia. Integrating ultrasound findings with clinical assessment enhances diagnostic accuracy and informs targeted therapeutic interventions.
5. Treat Etiology (Minutes 20–30)
Once the underlying cause of shock is identified, specific treatments should be promptly initiated. For instance, administering antibiotics for septic shock, performing pericardiocentesis for cardiac tamponade, or providing thrombolytics for massive pulmonary embolism. Addressing the root cause is essential for reversing the shock state and preventing further deterioration.
6. Stabilise (Within 30 Minutes)
The final step focuses on stabilising the patient's condition by ensuring adequate organ perfusion and monitoring response to interventions. Continuous reassessment is vital to detect any changes in clinical status and to adjust treatment plans accordingly. This phase also involves preparing for definitive care, which may include transfer to an intensive care unit or surgical intervention.
Implementing the MINUTES bundle provides a systematic and timely approach to managing undifferentiated shock, emphasising the importance of early recognition and intervention to improve patient outcomes.
Source: International Journal of Emergency Medicine
Image Credit: ISICEM 2025
