TY  - CHAP
M1  - Book, Section
TI  - Chapter 21. Shock
A1  - Walley, Keith R.
A2  - Hall, Jesse B.
A2  - Schmidt, Gregory A.
A2  - Wood, Lawrence D.H.
PY  - 2005
T2  - Principles of Critical Care, 3e
AB  - Shock  is  present  when  there  is  evidence  of  multisystem  organ  hypoperfusion;  it  often  presents  as  decreased  mean  blood  pressure.Initial  resuscitation  aims  to  establish  adequate  airway,  breathing,  and  circulation.  Rapid  initial  resusciation  (usefully  driven  by  protocol)  is  fundamental  for  improved  outcome,  since  “time  is  tissue.”A  working  diagnosis  or  clinical  hypothesis  of  the  cause  of  inadequate  circulation  should  always  be  made  immediately,  while  treatment  is  initiated,  based  on  clinical  presentation,  physical  examination,  and  by  observing  the  response  to  therapy.Drug  and/or  definitive  therapy  for  specific  causes  of  shock  must  be  considered  and  implemented  early  (e.g.,  thrombolysis  for  myocardial  infarction,  hemostasis  for  hemorrhage,  appropropriate  antibiotics,  and  activated  protein  C  for  severe  sepsis,  etc.).The  most  common  causes  of  shock  are  high  cardiac  output  hypotension,  or  septic  shock;  reduced  pump  function  of  the  heart,  or  cardiogenic  shock;  and  reduced  venous  return  despite  normal  pump  function,  or  hypovolemic  shock.  Overlapping  etiologies  can  confuse  the  diagnosis,  as  can  a  short  list  of  other  less  common  etiologies,  which  are  often  separated  by  echocardiography  and  pulmonary  artery  catheterization.Shock  has  a  hemodynamic  component,  which  is  the  focus  of  the  initial  resuscitation,  but  shock  also  has  a  systemic  inflammatory  component  (ameliorated  by  rapid  initial  resuscitation)  that  leads  to  adverse  sequelae  including  subsequent  organ  system  dysfunction.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2022/08/16
UR  - accessmedicine.mhmedical.com/content.aspx?aid=2284371
ER  -