This is the podcast surgery. I see rounds. My name is Jeff Guy. I am an associate professor of surgery at Vanderbilt University Medical Center and the director of the burn unit there.

Today is Monday, the 31st of March 2008. The topic that I'd like to discuss is traumatic shock and fluid resuscitation.

Most people think that they have a pretty good concept of what shock really represents or what

it means, and it's important to realize that shock is not defined by a blood pressure.

Shock is really defined as the inadequate delivery of oxygen to various tissues, and

this inadequate delivery of oxygen to various tissues. And this inadequate delivery of oxygen to different cells, of be it the heart, the lung, the kidney, the brain,

actually will cause the cells to not function properly.

When cells don't function properly, tissues don't function properly, then organs don't function properly,

and then you get into conditions such as multi-organ dysfunction and even death.

The care delivered in the first several minutes after a patient is injured is really essential

in determining the trajectory of how a patient is going to do even after they've been

taken to a local hospital and have had their source of their blood loss arrested and

the patients resuscitated.

Allowing a patient to sit into a state of shock can certainly lead the problems. Now, as I said, shock is

really not defined by a particular blood pressure. A patient could have a heart rate that's normal.

They could have a blood pressure that's normal. Now, the heart rate may be normal in somebody who,

for instance, is on a medication, such as like a cardism or a beta blocker or

dejoxin, something that's providing some cardiac protection.

The blood pressure might be normal.

If you look at the tenements of advanced trauma life support, which is the course that most physicians take

who may be taking, providing any emergency care to trauma victims, it's of course produced and disseminated by the American College of surgeons

you really don't see a real significant drop in the blood pressure until the patient's

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