Shock

Remember that Oxygen Delivery is composed of two parts:

What is Shock?

[Oxygen Delivery] = [Oxygen Content] [Cardiac Output]

In the first video, let’s go over problems with that second part: cardiac output.

How can cardiac output go wrong? All of these can lead to decreased cardiac output.

  • Cardiac: problems with the PUMP. The heart won’t push blood forward.
  • Blood vessels: problems with the PIPES. The blood vessels are causing either obstruction to flow or are so massively dilated that blood just pools within or leaks out.
  • Fluid volume: problems with the TANK. There’s not enough fluid to pump around.

The commonly taught categories of causes of cardiogenic, obstructive, distributive and hypovolemic fit into the above three physiologic groups.

How do you diagnose shock?

You can recognize shock by hypoperfusion of organ systems. So you’ll find measured blood pressure is low. Also, decreased blood flow to the

  • kidneys leads to decreased urine output
  • brain leads to altered mental status
  • skin leads to cyanosis.

Remember that H&P are the best diagnostic tools we have. So search for potential signs and symptoms for diseases of the pump, pipes or tank. Ultrasound (the RUSH protocol) is very helpful as well. Treatment depends on identifying the cause.

How do you treat shock?

Treatment depends on the cause of hypoperfusion.

  • PUMP problem? Maybe you need an inotrope or other cardiac support
  • TANK problem? Then fill up the tank. Use whatever fluid you need, but remember crystalloid doesn’t carry oxygen.
  • PIPE problem? Then, assuming you have a full tank, you need a pressor.
Shock

Odds vs Risk Ratios

Odds ratios and risk ratios always confused me. I never really understood the reason behind having an odds ratio. It is so unintuitive to me, even still.

There’s a great article from the Southern Medical Journal that explains it all! Watch the video then read the article.

Viera AJ. Odds ratios and risk ratios: what’s the difference and why does it matter? South Med J. 2008 Jul;101(7):730-4. PMID: 18580722

Gallery

Systematic Reviews and Meta-Analyses

Systematic reviews sit atop the evidence-based medicine pyramid as the strongest form of evidence we have. This is so because it incorporates more data than individual studies. To avoid bias in making reviews, the authors need to follow a systematic process. In this video we look at this process the authors would follow and you should note when reading such reviews.

Gallery

The Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act, also known as the Affordable Care Act or ObamaCare, is the biggest change in health care policy since Medicare in 1965. Despite its importance, very few understand it. This is not surprising given its complexity. Popular news outlets and politicians (on both sides) capitalize on our ignorance by exaggerating, distorting or misrepresenting pieces of it. As health care providers and citizens, love it or hate it, we have a duty to understand it.
Continue reading “The Patient Protection and Affordable Care Act”

The Patient Protection and Affordable Care Act

Active Shooter

Today, September 16, 2013, marks yet another day when a gunman opened fire upon civilians, killing unnecessarily. It seems that this is happening more frequently, and it would be foolish to think it is limited to schools, movie theaters and military compounds. As grim as it sounds, we should open the conversation as to what would we do? Is it possible to prepare. In this episode of EM:RAP, Ilene Claudius speaks with Mike Clumpner, paramedic, PhD, and active shooter expert. A lot of this seemed counter-intuitive to me.

Listen and feel free to comment below.

active_shooter

Active Shooter