RT Book, Section A1 Massaro, Anthony F. A2 Jameson, J. Larry A2 Fauci, Anthony S. A2 Kasper, Dennis L. A2 Hauser, Stephen L. A2 Longo, Dan L. A2 Loscalzo, Joseph SR Print(0) ID 1155976945 T1 Approach to the Patient with Shock T2 Harrison's Principles of Internal Medicine, 20e YR 2018 FD 2018 PB McGraw-Hill Education PP New York, NY SN 9781259644016 LK accessmedicine.mhmedical.com/content.aspx?aid=1155976945 RD 2024/03/28 AB Shock is the clinical condition of organ dysfunction resulting from an imbalance between cellular oxygen supply and demand. This life-threatening condition is common in the intensive care unit (ICU). There are a multitude of heterogeneous disease processes that can lead to shock. The organ dysfunction seen in early shock is reversible with restoration of adequate oxygen supply. Left untreated, shock transitions from this reversible phase to an irreversible phase and death from multisystem organ dysfunction (MSOF). The clinician is required to identify the patient with shock promptly, make a preliminary assessment of the type of shock present, and initiate therapy to prevent irreversible organ dysfunction and death. In this chapter, we review a commonly used classification system that organizes shock into four major types based on the underlying physiologic derangement. We discuss the initial assessment utilizing the history, physical examination, and initial diagnostic testing to confirm the presence of shock and determine the type of shock causing the organ dysfunction. Finally, we will discuss key principles of initial therapy with the aim of reducing the high morbidity and mortality associated with shock.