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

Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society 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 comparison of the shock index and conventional vital signs to identify acute, critical illness in 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 therapy in the treatment of severe sepsis and 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