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EM Clerkship

Circulation (Shock)

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9816 Ratings

🗓️ 26 April 2016

⏱️ 9 minutes

🧾️ Download transcript

Summary


Tank. Clogged Pipes. Broken Pipes. Pump.



Introduction



* “Tank”* Hypovolemic shock* Hemorrhagic shock* “Clogged Pipes”* Cardiac tamponade* Tension pneumothorax* Pulmonary embolism* “Broken Pipes”* Septic Shock* Neurogenic Shock* Anaphylactic Shock* “Pump”* Cardiogenic Shock



Step 1: Fill the Tank



* Establish an IV* IO line alternative in emergent situations



Step 2: Consider Clogs



* Cardiac tamponade* Diagnosis: Ultrasound* Treatment: Pericardiocentesis* Tension pneumothorax* Diagnosis: Clinical/Xray/Ultrasound* Treatment: Needle decompression and tube thoracostomy* Pulmonary embolism* Diagnosis: Clinical/CTA* Treatment: Thrombolytics



Step 3: Squeeze the Pipes



* Administer vasopressors* Most common: Norepinephrine* Alternatives: Epinephrine, Phenylepherine



Step 4: Analyze the Pump



* Get an EKG* Ischemia = Aspirin/Heparin/Cath lab* Dysrhythmia = Electricity



Additional Reading



* Airway Part 1 – Immediate Actions (EM Clerkship)* Breathing (EM Clerkship)* RUSH Exam (EMCrit)

Transcript

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0:00.0

Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of

0:07.1

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0:11.9

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0:24.7

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0:29.5

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0:34.1

and you can cancel at any time if you decide it's not right for you. You can learn more

0:38.9

at www.gitfreed.a.i.

0:45.6

Hello, med students. My name is Zach Olson, and today is episode C, circulation. It is sadly the third and final episode in our series about the

0:58.0

approach to a crashing patient. Now from the beginning, my goal has been to teach you a calm,

1:05.3

immediate, and methodical, A, B, C, approach, so that you can control literally any situation and really impress your

1:16.2

attendings when you're on your shifts.

1:18.5

So far, we talked about airway, how intubation doesn't actually have to be the first step

1:23.2

and how what you should really be thinking is suction and move the tongue.

1:28.5

We talked about breathing, how you can fix hypoxia just by adding FIO2 and peep.

1:35.7

And now is the final episode.

1:38.3

Circulation in 60 seconds.

1:41.4

I want to give a special shout out to my attending, Dr. Silberman.

1:45.0

He actually taught me this, gave a lecture on this in conference, and inspired this whole

1:49.1

episode.

1:50.0

So I really appreciated it, Dr. Silberman.

1:52.5

I still have never actually heard a better summary of this topic.

...

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