Episode 7 - Shock Talk I: Pathophysiology & Classification

Trauma ICU Rounds

Dr. Dennis Kim

Emergency General Surgery, Critical Care, Foam, Intensive Care, Education, Health & Fitness, Science, Life Sciences, Acute Care Surgery, Trauma Surgery, Medicine, Medical Education

4.8 • 663 Ratings

🗓️ 24 April 2020

⏱️ 23 minutes

🔗️ Recording | iTunes | RSS

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Summary

What is shock? A clear grasp of this concept is a MUST for any practitioner taking care of patients. Shock is many things. It is dynamic. It is elusive. It is lethal. A high index of suspicion is required to identify patients in shock. While lifesaving therapies are initiated, we must have an organized approach to to shock in order to identify the best diagnostic and therapeutic pathways for our patients. As such, we will review a simple classification system for shock. In a follow-up episode...

Transcript

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0:00.0	From the classroom to the emergency room, O.R. and beyond. You're joining Trauma ICU Rounds with your host, Dr. Dennis Kim.
0:12.4	I'd like to welcome you to trauma ICU rounds. I'm your host, Dr. Dennis Kim. On rounds today, we're going to discuss one of my favorite topics, and that is shock.
0:26.4	It's no secret that patients who develop shock, irrespective of ideology, are at an increased risk for morbidity as well as mortality, and that the ability to both recognize and institute
0:32.6	therapy for patients in shock is a fundamental skill in the trauma surgeon's toolbox and probably one of
0:38.8	the major reasons many of us decide to dedicate ourselves to the art and science of resuscitation
0:43.6	or trauma surgical critical care as a specialty.
0:47.7	Over the course of the next 25 to 30 minutes, we're going to review the mechanisms and pathophysiology
0:53.1	of shock. We'll also discuss the
0:55.4	importance of having a high index of suspicion for identifying this dynamic and, oftentimes,
1:01.4	elusive condition. Further, we'll review the four major categories of shock. A point that I do
1:07.3	want to emphasize right off the bat is that similar to when we encounter a patient with acute respiratory failure, we do not require definitive confirmation of the
1:15.9	type of shock before initiating therapy.
1:19.3	And as we'll discuss in the follow-up Shock Talk 2 episode, early management of shock is
1:24.7	fundamentally the same irrespective of the category or ideology of the shock
1:29.5	with some subtle nuances. I think many of the house staff, trauma surgical ICU staff, and others around
1:35.9	here are very familiar with my shock mantra of fill them, press them, squeeze them. So there are three
1:42.2	key objectives for today's rounds, and by the end of rounds,
1:45.3	you should be able to, number one, understand the common pathophysiologic mechanisms underlying
1:50.9	shock. Number two, immediately recall the four categories of shock, and finally, be able to provide
1:57.9	a differential diagnosis for the four most common causes of shock.
2:02.5	So when we say that a patient is in shock, what exactly do we mean?
2:06.8	Well, in its simplest form, shock is inadequate delivery of oxygen and nutrients that are necessary for normal tissue and cellular function.
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