Shock *

Objectives (EM)

1. In certain patient populations that may present in non-specific or atypical ways (e.g., pediatric, pregnant, elderly), recognize subtle signs of shock.
2. Given a patient presenting with dehydration, accurately quantify the degree of fluid deficit, taking into account the age of the patient.
3. In patients presenting with shock, resuscitate with the appropriate fluid for their condition (e.g., blood, crystalloid, colloid).
4. Given a patient presenting in septic shock, treat aggressively and use clinical information to guide ongoing management (e.g., appropriate fluid resuscitation, evidence-based antibiotic choices, clinical reassessment).
5. In patients presenting in shock, actively seek diagnoses beyond hypovolemia (e.g., cardiogenic, spinal, toxicological, anaphylactic).
6. In patients in shock, use ancillary tests as appropriate to aid in narrowing your differential etiologic diagnoses (e.g., ultrasound, CXR, ECG).
7. Given a patient in shock requiring vasopressors, select the most appropriate agent based on etiology and clinical presentation.
8. Given a patient in shock, administer non-fluid management where appropriate (e.g., steroids in Addison’s disease, antidotes in toxicology).