Review Article| Volume 24, ISSUE 4, P775-789, December 2003

The evaluation and management of shock

      Shock is recognized at the bedside when hemodynamic instability leads to hypoperfusion of several organ systems. Accordingly, shock is a clinical diagnosis. Successful management of shock requires a primary survey directed at formulation of a working diagnosis and urgent initial resuscitation. The clinical response to initial measures to restore organ perfusion then confirms or changes the working diagnosis. This allows the clinician a pause to ponder the broader differential diagnosis of the types of shock and the pathophysiology of shock, which leads to early definitive therapy of the underlying cause of shock. Shock has a hemodynamic component, which is the initial focus of resuscitation, but shock also has a systemic inflammatory component that leads to multiple system organ failure. In this article, we present a simplified approach to diagnosis and management of shock and emphasize the tempo of resuscitation. The ultimate goal is to restore tissue perfusion in a timely fashion to prevent the development of multiple organ failure, which has a high mortality.
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