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Circulatory Shock

Saturday, November 9, 2013

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Source Name: The New England Journal of Medicine


Jean-Louis Vincent and Daniel De Backer

This is a review article of the diagnosis and treatment of the various forms of shock. The treatment of septic shock is well expounded as this makes up 62% of cases of shock in the ICU. Norepinephrine is the first choice of vasopressor agents and dopamine is discouraged due to its arrhythmogenicity. Dobutamine is the first choice of inotropic agents for increasing CO. Low dose of vasopressin in distributive shock is safe and has a survival benefit. Adequacy of circulation is measured by mixed venous saturation with a target of at least 70%. A decrease in blood lactate level signifies effective therapy. The conclusion discusses the four phases of treatment of shock: salvage, optimization, stabilization and deescalation.

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