Re-Imaginging The Approach to Patients in Shock
Вставка
- Опубліковано 4 сер 2024
- Critical care and emergency medicine expert Dr. Sarah Sarah Crager introduces a new way of thinking about shock and challenges the traditional categorization of shock into four types: distributive, cardiogenic, hypovolemic, and obstructive. She highlights the limitations of this classification system and emphasizes the importance of considering shock precipitants and shock physiology as distinct entities.
Dr. Crager introduces the "tank pipes pump" model as an alternative approach to understanding shock. While this model helps gather data using ultrasound, she cautions against returning to the same old categories and limited treatment options. Instead, she advocates for a paradigm shift in thinking about shock.
The key takeaway is that shock is not solely about hypotension but rather hypoperfusion. Blood pressure and tissue perfusion are not always closely linked, and microcirculatory dysfunction can have significant implications for patient outcomes independent of macrocirculatory parameters. Dr. Crager emphasizes the importance of considering tissue perfusion and microcirculation, rather than solely focusing on blood pressure and forward pressures.
She challenges the prevalent blood pressure obsession in medicine and suggests a shift towards understanding the role of backward pressures and external pressures, such as tissue hydrostatic pressure, in shock. By incorporating forward, backward, and external pressures, Dr. Crager proposes a new way of approaching shock as a perfusion pressure problem.
Dr. Crager concludes by discussing the practical application of this approach at the bedside, using a patient's circulatory system map and considering the patient's specific condition. She encourages healthcare professionals to reframe their understanding of shock and consider perfusion pressure as a holistic concept in order to improve patient care.
Overall, this UA-cam video offers a thought-provoking perspective on shock and provides a foundation for further exploration and discussion in the field of critical care and emergency medicine.
00:00 Introduction to Reframing Shock
00:42 The Problem with Traditional Shock Models
01:20 The Disconnect Between Shock Precipitants and Shock Physiology
02:52 The Limitations of Ultrasound in Shock Diagnosis
03:31 The Inadequacy of Current Treatment Models
04:19 The Need for a New Approach
04:50 Understanding Shock as Hypoperfusion, Not Hypotension
05:08 The Importance of Microcirculation in Shock
07:03 The Misconception of Blood Pressure in Shock
08:16 The Role of Forward, Backward, and External Pressures in Shock
11:35 Applying the 3-Pressures Model to Patient Care
13:21 Conclusion: The Impact of Reframing Shock
What an excellent way of thinking about shock differently. Why didn't we think of this before? I am definitly looking forward to part 2 on this topic. I hope there will be one
You can check out all her lectures on ResusX.com
Sarah. incredibly insightful, and extraordinarily helpful and informative, as always. I'm always amazed during your lectures. they're like going to Disney World for docs. thank you so very much.
tom fiero, ed doc, merced ca.
Great comment Tom!
Love this mental model. Can’t wait for the next instalment in this series!
Thanks! Glad you
Like them
Love listening to yr talks and I feel I learn a lot
Working in the ICU we have learnt to look at diff no such as CVP, MAP, no’s or the flow track, pulse perfusion variation,svv, lactate levels and at our base deficit
Would be nice if you could discuss a case study on what exactly you are trying to tell us
Looking forward to more lectures
Thank you for taking yr time and educating us🙏🙏🙏
Glad you enjoyed her lectures!
@criticalcarenow. I like it...but can you do this in the prehospital setting? If so, how? It could be game changing
Can you link the research articles used in the lecture?
I contact Dr. Crager for the references
Great lecture!
Backward pressure in the peripherally= CVP ?. Cardiac pressure can be estimated by PCWP or LVEDP? As far as the forward pressure, the SVR or MAP can be used? Other than tamponade/tension/ascites/high IAP, how can you calculate external pressure at bedside?
Hope she sees this comment to respond. Thanks
Listening to your lecture I feel like we are talking about invasive versus invasive ways to learn more about LVEDP - LAP and PCWP. Your lecture makes me believe that most of our sick patient should have swan and we should follow th numbers. Otherwise I dont know how can you get Forward/ Backward and external pressure. Correct me if am wrong. Thanks
Great comment. Thanks