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
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.
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
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
Happy New Year!! Hopefully you got a bit of downtime over the festive period and are feeling suitably refreshed and ready to attack 2019!
We've got 3 great papers to kick off the year. First up we look at the recent PReVENT trial which looks at ventilator strategies in patients without ARDS with respect to tidal volumes. This paper continues the work from the much cited ARDSNet paper from 2000, and we'd highly recommend you go and have a look at that paper first.
Next we look at another paper from JAMA which compares Thrombolysis to Aspirin in minor non-disabling strokes. We say enough about this one in the podcast, but for a bit of background to our thoughts and the evidence surrounding stroke, check out our previous Stroke Thrombolysis podcast.
Lastly we have a look at a paper investigating their systems use of push-dose-pressors, which whilst not the most methodologically sound piece of research, certainly brings out some interesting thoughts and points.
As always make sure you take a look at the papers yourselves and we'd love to hear and comments or feedback you've got.
Simon & Rob
References & Further Reading
Ventilationwith lowertidal volumesas comparedwith traditionaltidal volumesfor acute lung injury and the acute respiratory distress syndrome. Acute Respiratory Distress SyndromeNetwork. N Engl J Med.2000