The Internet Book of Critical Care Podcast IBCC Episode 20 - Shock
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Jan 17, 2019 This podcast discusses the basics of recognizing and diagnosing shock, including the importance of assessing urine output and skin perfusion. It also explores the controversy surrounding lactate as a marker of shock and the limitations of central venous oxygen saturation. The podcast emphasizes the significance of evaluating the patient's clinical context and utilizing diagnostic tools such as bedside echo and labs. Additionally, it explores the use of steroids in treating shock and the potential benefits of stress-dose steroids in severe cases.
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Shock: The Final Pathway
- Shock is the final common pathway before death, excluding sudden cardiac death.
- Recognizing and diagnosing the cause of shock is crucial, as each type is lethal.
Varying Presentations of Shock
- Septic shock patients may appear flushed with warm extremities and bounding pulses.
- Cardiogenic shock patients might look better, but exhibit cool skin, mottling, and narrow pulse pressure due to vasoconstriction.
Utilizing the Shock Index
- Use the shock index (heart rate/systolic BP) to assess patients with borderline low blood pressure.
- This helps differentiate true shock from simply low blood pressure.