This is the podcast ICU rounds. My name's Jeff Guy. I'm an associate professor of surgery and director of the burn center at Vanderbilt University. Today, the topic that I want to discuss are some of the pharmacology issues of the treatment of shock. In some previous episodes of our podcast, we've talked about issues of septic shock and we've

talked about the use of fluids and vasopressers.

In this particular episode, I want to talk about some basic concepts of shock and what are

some of the drug therapies that are used to help treat the cardiovascular effects of the various types of shock.

First of all, it's important to discuss what actually is shock.

And it's really inappropriate to think of shock as defined by a particular blood pressure.

Often we talk about somebody having a systolic blood pressure of 80 or

somebody with a mean arterial pressure of 80 or somebody with a mean arterial

pressure of 60, or 65 as having shock.

But really, shock is defined as inadequate auction delivery for a particular tissue

bed.

Whenever the oxygen demands of a particular tissue bed exceed that of the oxygen delivery, it's fair to say

that the patient is suffering from shock.

Now this can actually occur somebody with a normal blood pressure.

For instance, if you have somebody who has inadequate tissue delivery to a peripheral bed

and then you give them a vasoconstrictor that elevates the blood pressure,

but in the result of increasing, or excuse me, of causing increased vasoconstriction,

decreases the flow to a peripheral tissue bed, you can have shock defined by inadequate auction delivery,

even in the face of a normal or improved blood pressure.

Now it is fair to say that we typically use blood pressure as the initial evaluation as somebody is in shock.

And even about a blood pressure cuff, a general reflection of blood pressure can be obtained by palpation of the peripheral pulses.

A bounding radial pulse readily indicates that your patient is not in shock,

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