The document discusses shock, defining it as inadequate blood flow to tissues to meet demand. It describes the different types of shock - hypovolaemic, cardiogenic, distributive, and obstructive - and their signs and causes. For treatment, it emphasizes early recognition of the underlying cause, ensuring oxygenation and perfusion through fluid resuscitation and vasopressors if needed, and treating the specific shock type through measures like antibiotics for sepsis or adrenaline for anaphylaxis. It provides clinical guidance on diagnosing and managing different shock etiologies in the emergency setting.
Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
Hypertension Emergencies and their managementpptxUzomaBende
This Presentation talks about Hyprtension, the mode of presentation of hypertensive crisis and the effective management of hypertensive crisis to prevent case fatalities.
Assessment and management of shock in acute trauma setting based on ATLS recommendations .Lecture given in Trauma update at Perintalmanna on19th August 2014.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Hypertension Emergencies and their managementpptxUzomaBende
This Presentation talks about Hyprtension, the mode of presentation of hypertensive crisis and the effective management of hypertensive crisis to prevent case fatalities.
Assessment and management of shock in acute trauma setting based on ATLS recommendations .Lecture given in Trauma update at Perintalmanna on19th August 2014.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. Definition of shock
• Shock is a state in which there is inadequate blood flow to the tissues to
meet demand.
• Shock and hypotension often co-exist, BUT a normal blood pressure DOES
NOT exclude the diagnosis of shock
• Imbalance between tissue supply and demand →Anaerobic Metabolism
→Lactic Acid Production
• The acute circulatory failure if prolonged, results in irreversible organ
failure.
• Mortality is high without early diagnosis and treatment.
Department of Anaesthesia and Intensive Care, the Chinese Universityof Hong Kong July 2015
Medical Guidelines Medicins Sans Fronteires on Shock
3. Clinical features-- Signs common to most forms of
shock
– Pallor, mottled skin, cold extremities, sweating and thirst.
– Rapid and weak pulse often only detected on major arteries (femoral or
carotid).
– Low blood pressure (BP), narrow pulse pressure, BP sometimes
undetectable.
– Capillary refill time (CRT) > 3 seconds.
– Cyanosis, dyspnoea, tachypnoea are often present in varying degrees
depending on the mechanism.
– Consciousness usually maintained, but anxiety, confusion, agitation or
apathy are common.
– Oliguria or anuria.
Medical Guidelines Medicins Sans Fronteires on Shock
4. Different types of Shock
1. Hypovolaemic
2. Cardiogenic
3. Distributive
4. Obstructive
Department of Anaesthesia and Intensive Care, the Chinese Universityof Hong Kong
July 2015
5. Signs specific to the mechanism of shock --
Hypovolaemic shock
• The common signs of shock listed above are typical of hypovolaemic
shock.
• Do not underestimate hypovolaemia. Signs of shock may not become
evident until a 50% loss of blood volume in adults.
Medical Guidelines Medicins Sans Fronteires on Shock
6. Distributive Shock
• Caused by maldistribution of blood flow from peripheral
vasodilatation and decrease in systemic vascular resistance (SVR)
(decreased afterload)
• Sepsis
• Anaphylaxis
• Neurogenic
7. Signs specific to the mechanism of shock - Septic
shock
– High fever or hypothermia (< 36 °C), rigors, confusion
– BP may be initially maintained, but rapidly, same pattern as for
hypovolaemic shock.
Medical Guidelines Medicins Sans Fronteires on Shock
8. Signs specific to the mechanism of shock -
Anaphylactic shock
– Significant and sudden drop in BP
– Tachycardia
– Frequent cutaneous signs: rash, urticaria, angioedema
– Respiratory signs: dyspnoea, bronchospasm
Medical Guidelines Medicins Sans Fronteires on Shock
9. Signs specific to the mechanism of shock -
Cardiogenic shock
– Respiratory signs of left ventricular failure (acute pulmonary oedema)
are dominant: tachypnoea, crepitations on auscultation.
– Signs of right ventricular failure: raised jugular venous pressure,
hepatojugular reflux, sometimes alone, more often associated with
signs of left ventricular failure.
Medical Guidelines Medicins Sans Fronteires on Shock
11. Trauma Patients
Can Present with A
Combination of
Different Types of
Shock
Jeremy Richards et al. Diagnosis And Management Of Shock In The
EmergencyDepartment. EmergencyMedicine Practice 2014, 16:3
12. The aetiological diagnosis is oriented by:
– The context: trauma, insect bite, ongoing medical treatment, etc.
– The clinical examination:
• fever
• skin pinch consistent with dehydration
• thoracic pain from a myocardial infarction or pulmonary embolus
• abdominal pain or rigidity of the abdominal wall from peritonitis,
abdominal distension from intestinal obstruction
• blood in stools, vomiting blood in intestinal haemorrhage
• subcutaneous crepitations, likely anaerobic infection
Medical Guidelines Medicins Sans Fronteires on Shock
13. Characteristics of different types of shock
Type of shock JVP/CVP Cardiac output (CO) Systemic vascular
resistance (SVR)
Clinically
Hypovolemic ↓ ↓ ↑ Cold and shut down
Cardiogenic ↑ ↓ ↑ Cold and shut down
Distributive ↓ ↓/-/↑ ↓ Warm and dilated
Obstructive ↑ ↓ ↑ Cold and shut down
Department of Anaesthesia and Intensive Care, the Chinese Universityof Hong Kong
July 2015
14. Lab studies
• FBC
• RP
• LFT
• Amylase
• Cardiac biomarkers
• ABG
• Cultures
• Lactate
Jeremy Richards et al. Diagnosis And Management Of Shock In The
EmergencyDepartment. EmergencyMedicine Practice 2014, 16:3
15. Imaging
• USS
• Maximal inferior vena cava diameter was better able to differentiate a central venous
pressure <10mmHg from a central venous pressure >10mmHg
• Abdominal aortic aneurysm
• Echo
• Cardiac ejection fraction to determine etiology of shock – depressed in cardiogenic shock
• Cardiac tamponade
• Aortic dissection
• Pulmonary embolism
• CXR
• Heart size, presence/absence of pulmonary edema/infiltrates/effusion/ pneumothorax
• CT scan
• Only if USS is inconclusive
Jeremy Richards et al. Diagnosis And Management Of Shock In The
EmergencyDepartment. EmergencyMedicine Practice 2014, 16:3
16. Management of Shock (General)
• Definitive treatment for patients in shock depends on the specific
etiology; however, this may not be immediately clear on initial
presentation
• Thus initiation of therapy and patient stabilization may occur
simultaneously with evaluation.
• The goals in treating patients in shock are restoring adequate organ
perfusion and oxygen delivery while considering/treating the possible
cause(s) of shock
Jeremy Richards et al. Diagnosis And Management Of Shock In The
EmergencyDepartment. EmergencyMedicine Practice 2014, 16:3
17. Initial Stabilization
• Airway
• Breathing
• Circulation
Jeremy Richards et al. Diagnosis And Management Of Shock In The
EmergencyDepartment. EmergencyMedicine Practice 2014, 16:3
18. Management of Shock (General)
• Early recognition and prompt treatment of the underlying cause of
shock
• Ensure oxygenation and maintain perfusion
• Usually aim for:
• Mean Arterial Pressure (MAP) ≥ 65mmHg .…. formula MAP = SBP + 2(DBP)
3
• Urine output ≥ 0.5ml/kg/hr
Department of Anaesthesia and Intensive Care, the Chinese Universityof Hong Kong
July 2015
19. Treatment – Monitoring
• Cardiovascular monitoring
• Cardiac monitoring, BP cuffs automated
Jeremy Richards et al. Diagnosis And Management Of Shock In The
EmergencyDepartment. EmergencyMedicine Practice 2014, 16:3
20. Treatment -- Fluid resuscitation
• Only approximately 50% of hypotensive patients are volume responsive
• Passive leg raise can rapidly, noninvasively and easily as a reversible tool to
assess volume responsiveness
• Leg is raised from horizontal to vertical position and then assess volume
responsiveness
• Crystalloid is usually used for the initial treatment of undifferentiated shock
Jeremy Richards et al. Diagnosis And Management Of Shock In The
EmergencyDepartment. EmergencyMedicine Practice 2014, 16:3
21. Management -- Vasopressor
• Once patient is euvolemic but there is still ineffective oxygen delivery,
vasoactive medications are likely required
• Vasopressor medications used to support mean arterial pressure by
increasing systemic vascular resistance and/or cardiac output
• Noradrenaline is a strong alpha agonist with some beta 1 activity and is a
recommended initial choice for most categories of shock
• Metaanalysis of 11 trials showed there is a statistically significant increased
risk of death associated with dopamine. Thus should not be used as a first
line pressor agent
Jeremy Richards et al. Diagnosis And Management Of Shock In The
EmergencyDepartment. EmergencyMedicine Practice 2014, 16:3
23. Restoring Blood Pressure
• Mean arterial pressure is the preferred blood pressure to target during resuscitation
• The recommended initial goal is 65 mm Hg. A higher goal of 80 to 85 mm Hg may help patients
with chronic hypertension, while a lower target may be better tolerated in patients with reduced
systolic function, older patients, and patients with end-stage liver disease
• After blood pressure falls below a critical threshold, tissue perfusion decreases linearly. That
critical threshold can vary between organ systems and individuals, and the target can later be
personalized based on global and regional perfusion as assessed with urine output, mental status,
or lactate clearance
• Decisions to titrate vasopressors to achieve mean arterial pressure goals should be balanced
against potential adverse effects, including arrhythmias, cardiovascular events, and ischemia
Siddharth Dugar et al Sepsis and septic shock: Guideline-based managementCLEVELAND CLINIC JOURNAL OF
MEDICINE VOLUME 87 • NUMBER 1 JANUARY 2020
24. Restoring Blood Pressure
• Norepinephrine is the first line vasopressor agent
• A second vasopressor is routinely added when norepinephrine doses
exceed 40 or 50 μg/min
• Epinephrine or vasopressin as second line vasopressor agent
Siddharth Dugar et al Sepsis and septic shock: Guideline-based managementCLEVELAND CLINIC JOURNAL OF
MEDICINE VOLUME 87 • NUMBER 1 JANUARY 2020
25. Hypovolaemic shock
- Due to inadequate circulating fluid volume
Causes:
- divided to haemorrhagic or non-haemorrhagic (major burns;
gastrointestinal losses: vomiting, fistulas; urinary losses: diabetes,
diabetes insipidus; evaporative losses with fever, abdominal surgery)
Management:
- fluid resuscitation
- haemorrhagic cause: transfusion of red cells and blood products.
- review source of bleeding and stop bleeding promptly
- use of hemostatic agent
Department of Anaesthesia and Intensive Care, the Chinese Universityof Hong Kong
July 2015
26. Cardiogenic shock
- due to cardiac pump failure resulting from myocardial or valvular failure
Causes:
- commonest: acute coronary syndrome
- other causes: arrhythmia, myocardial contusions post-trauma; myocarditis; acute valvular dysfunction;
cardiomyopathy
- echo is very useful in reviewing the cause and monitor the progress
Management:
- Acute Coronary Syndrome (ACS): reperfusion by fibrinolytics or Per Cutaneous Intervention (angiogram ±
angioplasty ± stenting)
- control arrhythmia: pharmacological, electrical: pacing/ cardioversion
- optimise preload by fluid: a trial of small bolus of fluid with close observation of CVP/BP trend
- inotropic support: augment myocardial contractility. Increasing diastolic blood pressure to increase coronary
perfusion pressure and flow
- afterload: vasodilator will cause further hypotension, use with caution in normotensive patients
- mechanical device: Intraaortic Ballon Pump (IABP), Extracorporeal Membrane Oxygenation (ECMO)
Department of Anaesthesia and Intensive Care, the Chinese Universityof Hong Kong
July 2015
27. Distributive shock
Due to peripheral vascular dilatation causes a fall in peripheral resistance. The
cardiac output is often increased but the perfusion of vital organs is comprised
because the body loses its ability to distribute blood properly (vasoplegia)
Causes:
- septic shock; anaphylaxis; neurogenic shock
Management:
- Fluid resus
- Septic shock: prompt antibiotics, source control
- Inotropic support: start when BP is refractory to fluid. Usually noradrenaline for
septic shock
- Anaphylaxis: SC/ IV/ IM adrenaline
Department of Anaesthesia and Intensive Care, the Chinese Universityof Hong Kong
July 2015
28. Anaphylactic Shock
• Mainstay of treatment is rapid administration of adrenaline
• Adrenaline should be administered immediately if anaphylaxis is
suspected.
• Adrenaline should be given intramuscularly if intravenous access is
not available; treatment should not be delayed by attempting to place
an intravenous line.
• The standard intramuscular dose of adrenaline is 0.3 mg to 0.5 mg in
a 1:1000 dilution, and dosing may be repeated every 3 to 5 minutes
as clinically indicated.
Jeremy Richards et al. Diagnosis And Management Of Shock In The
EmergencyDepartment. EmergencyMedicine Practice 2014, 16:3
29. 2016 Sepsis-3 committee – Sepsis Definition
• Sepsis—A life-threatening condition caused by a dysregulated host
response to infection, resulting in organ dysfunction
• Septic shock—Circulatory, cellular, and metabolic abnormalities in
septic patients, presenting as fluid-refractory hypotension requiring
vasopressor therapy with associated tissue hypoperfusion (lactate > 2
mmol/L
Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Defi nitions for
Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315(8):801–810. doi:10.1001/jama.2016.0287
30. Septic Shock
• Starting with broad-spectrum antimicrobials, particularly in the setting of
hypotension, and then rapidly de-escalating to an antimicrobial with the
narrowest spectrum based on local sensitivity patterns.
• If the clinical course suggests the illness is not actually due to infection, the
antibiotics should be stopped immediately
• Antibiotics de-escalation should be discussed daily. A 7- to 10-day course or
even shorter may be appropriate for most infections, although a longer
course may be needed if source control cannot be achieved, in
immunocompromised hosts, and in S aureusbacteremia, endocarditis, or
fungal infections
Siddharth Dugar et al Sepsis and septic shock: Guideline-based managementCLEVELAND CLINIC JOURNAL OF
MEDICINE VOLUME 87 • NUMBER 1 JANUARY 2020
31. Sepsis and Death – Delay in Antibiotics
• Retrospective study of 35,000 randomly
selected inpatients with sepsis treated at 21
emergency departments between 2010 and
2013 in Northern California
• The primary exposure was antibiotics given
within 6 hours of emergency department
registration
• Primary outcome was adjusted in-hospital
mortality
Even a 6 hour delay will increase
death rates by 2 fold
Liu, Fielding-Singh, Greene, et al.: Timing of Early Antibiotics in Sepsis American Journal of
Respiratory and Critical Care MedicineVolume 196 Number 7 | October 1 2017, 856-863
32. Septic Shock – Fluid Resuscitation
• Rescue: During the initial minutes to hours, fluid boluses (a 1- to 2-L fluid
bolus of crystalloid/balanced crystalloid solution) are required to reverse
hypoperfusion and shock
• Optimization: During the second phase, the benefits of giving additional
fluid to improve cardiac output and tissue perfusion should be weighed
against potential harms
• Stabilization: During the third phase, usually 24 to 48 hours after the onset
of septic shock, an attempt should be made to achieve a net-neutral or a
slightly negative fluid balance
• De-escalation: The fourth phase, marked by shock resolution and organ
recovery, should trigger aggressive fluid removal strategies
Siddharth Dugar et al Sepsis and septic shock: Guideline-based managementCLEVELAND CLINIC JOURNAL OF
MEDICINE VOLUME 87 • NUMBER 1 JANUARY 2020
33. Septic Shock – Fluid resuscitation
• Within the first 3 hours patients have a lactate level checked, blood
cultures drawn prior to antibiotics, broad-spectrum antibiotics given, and
30mL/kg of crystalloid/balanced crystalloid given for hypotension or lactate
≥ 4 mmol/L.
• Within 6 hours, vasopressors should be started for hypotension that does
not respond to fluid resuscitation to maintain a mean arterial pressure ≥ 65
mm Hg.
• Measuring the lactate level is an objective way to assess response to
resuscitation, better than other clinical markers, and it continues to be an
integral part of sepsis definitions and the Surviving Sepsis Campaign care
bundle
Jeremy Richards et al. Diagnosis And Management Of Shock In The Emergency Department. Emergency
Medicine Practice2014, 16:3
Siddharth Dugar et al Sepsis and septic shock: Guideline-based managementCLEVELAND CLINIC JOURNAL OF
MEDICINE VOLUME 87 • NUMBER 1 JANUARY 2020
34. Septic Shock – Source Control
• Source control can range from removal of infected intravascular
devices to a chest tube for empyema to percutaneous or surgical
intervention in cases of cholecystitis and pyelonephritis
Siddharth Dugar et al Sepsis and septic shock: Guideline-based managementCLEVELAND CLINIC JOURNAL OF
MEDICINE VOLUME 87 • NUMBER 1 JANUARY 2020
35. Septic Shock – Role of corticosteroids
• In septic shock, they have a vasopressor-sparing role and reduce the duration of
shock, ventilator use, and ICU stay
• However, the evidence is not conclusive that giving corticosteroids for sepsis
improves clinical outcomes or survival
• They can be added as adjunctive therapy for patients requiring higher doses of
vasopressors
• If corticosteroids are used in septic shock, current guidelines recommend
hydrocortisone 200 mg per day intravenously as a continuous drip or 50 mg bolus
in 4 divided doses for at least 3 days
Siddharth Dugar et al Sepsis and septic shock: Guideline-based managementCLEVELAND CLINIC JOURNAL OF
MEDICINE VOLUME 87 • NUMBER 1 JANUARY 2020
36. Septic Shock – Biomarkers
• C-reactive protein and erythrocyte sedimentation rate have been
used in the past, but with limited success
• Procalcitonin has emerged as a method to help detect bacterial
infections early and to guide de-escalation or discontinuation of
antibiotics.
• Galactomannan and beta-D-glucan can be used to detect infections
with fungi, specially Aspergillus. Beta-d-glucan is more sensitive for
invasive Aspergillus, while galactomannan is more specific
Siddharth Dugar et al Sepsis and septic shock: Guideline-based managementCLEVELAND CLINIC JOURNAL OF
MEDICINE VOLUME 87 • NUMBER 1 JANUARY 2020
37. Obstructive shock
Due to obstruction of great vessels or heart that impedes the blood flow
Causes:
- cardiac tamponade; tension pneumothorax; pulmonary or air embolism
Mangement:
- Prompt relief of obstruction: e.g. pericardiocentesis for tamponade,
chest drain for tension pneumothorax
- Fluid and inotrope are for temporary support
Department of Anaesthesia and Intensive Care, the Chinese Universityof Hong Kong
July 2015
38. Pitfalls
Jeremy Richards et al. Diagnosis And Management Of Shock In The
EmergencyDepartment. EmergencyMedicine Practice 2014, 16:3