If you're involved in the care of critically unwell patients then you will frequently encounter patients who are shocked. The European Society of Intensive Care Medicine defines shock as;
'Life-threatening, generalized form of acute circulatory failure associated with inadequate oxygen utilization by the cells. It is a state in which the circulation is unable to deliver sufficient oxygen to meet the demands of the tissues, resulting in cellular dysfunction.’
The assessment for shock needs to be part of the routine workup of every potentially unwell patient. Shock carries with it a high mortality rate, a range of meaningful interventions and the potential to make a real difference to our patients' outcomes.
In this podcast we cover
- Defining shock in adults
- Significance of shock
- What shock looks like
- A recap of cardiac physiology
- Causes of shock
- Ultrasound evaluation
- Fluid therapy
- Inotropes and vasopressors
As always we’d love to hear any thoughts or comments you have on the website and via twitter, we look forward to hearing from you.
Enjoy!
Simon, Rob & James
References
Consensuson circulatory shockand hemodynamic monitoring. Task forceof the EuropeanSociety of Intensive Care Medicine. Cecconi M. Intensive Care Med.2014
NICE Intravenous fluid therapy in adults in hospital. Clinical guideline. December 2013
ALIEM; Choosing the right vasopressor agent in hypotension
Resus; The Shock Index
ALIEM; Shock Index: A Predictor of Morbidity and Mortality?
A comparisonof the shockindexand conventionalvital signsto identifyacute, critical illnessin the emergency department. Rady MY. Ann Emerg Med.1994
TheResusRoom; Sepsis
RCEM guidance; Noradrenaline Infusion
Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol. Puskarich MA. Crit Care Med. 2011
Early goal-directed therapy in the treatment of severe sepsis and septic shock.Rivers E. N Engl J Med. 2001
Early lactate clearance is associated with improved outcome in severe sepsis and septic shock.Nguyen HB. Crit Care Med. 2004
Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial.Jones AE. JAMA. 2010
A randomized trial of protocol-based care for early septic shock.ProCESS Investigators. N Engl J Med. 2014
Early goal-directed therapyin the treatmentof severe sepsisand septic shock. Rivers E. N Engl J Med.2001
The significance of non-sustained hypotension in emergency department patients with sepsis.Marchick MR. Intensive Care Med. 2009
Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis.Natthida Owattanapanich. Scand J Trauma Resusc Emerg Med. 2018.
TheResusRoom; The Crystalloid Debate
The Resus Room