Conventional approach

The conventional clinical approach to shock is based on imprecise signs and symptoms such as cold clammy skin, altered mental status, weak thready pulse, and unstable vital signs. These subjective and observer-dependent findings are inadequate. They are seriously misleading for three reasons.

1. The signs and symptoms are the same for each etiological type of shock: they all have oliguria, tachycardia, and cardiovascular collapse.

2. The laboratory is not at all diagnostic.

3. The pathophysiology based on a one-dimensional description of each monitored variable fails to consider the interactions of the three major circulatory components: cardiac function, pulmonary function, and tissue perfusion. Tissue perfusion and oxygenation represents the important overall purpose of the circulation to supply body metabolism.

The most commonly monitored variables in hospital in-patients are the mean arterial pressure, heart rate, central venous pressure, and cardiac output. These are measured with the aim of using therapy to bring the values back into the normal range. In several thousand monitored values of patients who died, 76 per cent were restored to the normal range; nevertheless, these patients still went on to die ( ShP®.m.§.k§LeLa!: 1988). Survivors had essentially the same values. Thus, something is wrong with the conventional approach to monitoring acutely ill or shocked patients. The wrong variables may be monitored, and normal values may be appropriate for normal healthy people but are not appropriate for critically ill patients, who require increased circulatory function because of their increased body metabolism.

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