 Welcome to the emergency medicine video on shock. We will discuss the general presentation and treatment of shock in Part 1. Then in Part 2 and 3, we will discuss the specific kinds of shock. What is shock? It is defined as inadequate oxygen delivery to tissue, causing poor perfusion. Shock can be compensated with normal blood pressure. Or decompensated if there is hypotension. The end result is end organ dysfunction. There are a few different end organs that we are interested in. The end organ dysfunction includes the heart. There will be arrhythmia, ischemia and hypotension. In the lung, the end organ dysfunction can include pulmonary edema and ARDS. Acute respiratory distress syndrome. In the central nervous system, shock can cause a decreased level of consciousness. A change in a level of consciousness leading to confusion or agitation. It can also cause strokes. In the liver, shock can cause liver enzymes to go up. It can also cause a liver function test to go up, leading to coagulopathy. Shock can also cause the kidney to fail as well, leading to acute renal failure. Those are the main end organ dysfunction in shock. Remember, patients does not need to be hypotensive if they are in compensated shock. One useful rule is the shock index, which equals to heart rate over your systolic blood pressure. If this number is over 1, that signifies a sicker patient. And therefore, if your heart rate is more than your systolic blood pressure, you have to worry about this sick patient. Given what you know about the end organ dysfunctions in shock, what do you think would be the kind of lab abnormalities we will see in shock patient? In the routine blood work, you may see a high white blood cell count. The platelet can be high or low based on where they are in the shock spectrum. Because of the kidney function, you may expect the electrolytes to be changed as well. Particularly, you want to watch for that potassium. By the same token, the creatinine and the BUI may be high. Due to the liver involvement, you may expect the LFTs to go up. And due to the coagulopathy, you may also expect the INR and PTT to go up. Based on the end organ dysfunction that is present in the heart, you may expect cardiac enzyme to go up as well. What about other diagnostic abnormalities? Based on the heart dysfunction, you may expect ischemia on ECG. You may be able to see arrhythmia as well. On a chest x-ray, you will be able to see ARDS and pulmonary edema. In a patient with stroke-like symptoms, clearly a CT head might show some abnormalities. What is the general approach in treating shock patient? Well, in general, like with all sick patients, the main treatment approach is ABC. First, airway. We first ensure the airway is patented. If there is not a patent airway, or if the patient has a decreased level of consciousness, we may want to intubate. Keep in mind that a few of the medications we give for intubation can cause further hypotension. Once the airway is secured, we want to look after breathing by giving 100% oxygen. Patients might also be put on a ventilator if they are paralyzed and not breathing on their own. For circulation, we give intravenous fluids. We often give crystalloids such as normal saline or ringer's lactate. If the fluids still do not increase tissue perfusion, we might add vasopressors. There are specific kinds which are suitable for specific type of shock. We'll discuss those in part 2 and 3. There are 5 main types of shock. They are septic, hypovolemic, obstructive, cardiogenic, and anaphylactic. We will discuss them in parts 2 and 3 using the basic approach we just discussed. Thank you for watching.