You establish intravenous access with a peripheral catheter and send basic labs. A focused physical examination demonstrates tachycardia without extra heart sounds or murmurs, right basilar crackles on lung auscultation, a benign abdomen, and 1+ lower extremity pitting edema. He is delirious and unable to answer questions. On arrival, the patient has the following vital signs: temperature, 38☌ heart rate, 130 beats/min blood pressure, 110/60 mm Hg respiratory rate, 34 breaths/min and oxygen saturation, 89% on room air. His son reports that earlier today, his father had been in his usual state of health, but this evening he found his father confused, with labored breathing. You are working in the ED late one evening when an 82-yearold man is brought in by his son. Adherence to evidence-based care of the specific causes of shock can optimize a patient’s chances of surviving this life-threatening condition. This issue reviews the 4 primary categories of shock as well as special categories, including shock in pregnancy, traumatic shock, septic shock, and cardiogenic shock in myocardial infarction. Determining the intravascular volume status of patients in shock is critical and aids in categorizing and informing treatment decisions. Prompt workup should be initiated with laboratory testing (especially of serum lactate levels) and imaging, as indicated. Assessment begins with identifying the need for critical interventions such as intubation, mechanical ventilation, or obtaining vascular access. While much is known regarding treatment of patients in shock, several controversies continue in the literature. The mechanisms that can result in shock are divided into 4 categories: (1) hypovolemic, (2) distributive, (3) cardiogenic, and (4) obstructive. Shock is a state of acute circulatory failure leading to decreased organ perfusion, with inadequate delivery of oxygenated blood to tissues and resultant end-organ dysfunction. Early Goal-Directed Therapy Protocol For Patients With Severe Sepsis And Septic Shock Pitfalls To Avoid In The Diagnosis And Management Of ShockĬlinical Pathway For Diagnosing And Managing Shock.In The March/April Issue of EM Practice Guidelines Update

Clinical Course In The Emergency DepartmentĬardiogenic Shock Due To Myocardial Infarction

The diagnosis of shock must include