LEARNING OBJECTIVES:

KNOWLEDGE: Students should be able to describe:

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SKILLS: Students should be able to:

HISTORY AND PHYSICAL EXAM:

COMMUNICATION SKILLS:

MANAGEMENT:

 

 

 

 

 

 

ATTITUDES AND PROFESSIONAL BEHAVIORS: Students should be able to:

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REFERENCES:

  1. Connors AF, Speroff T, Dawson NV, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA 1996;276:889-897. This famous prospective cohort study found worse outcome with use of PACs in the critically ill, instantly becoming a source of enormous controversy. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8782638

  2. Richard C, Warszawski J, Anguel N, et al. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. JAMA 2003;290:2713-20. This multicenter study of 676 patients with common indications for PA catheter placement in the MICU found neither harm nor benefit with catheter placement.  Management based on catheter-derived data was at the discretion of the attending physician rather than by protocol.  In the control arm, 78% of patients underwent echocardiography.  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14645314&query_hl=1&itool=pubmed_docsum   

Specific Strategies for Resuscitating Patients in Shock

  1. Rivers E, et al. Early Goal Directed Therapy in the Treatment of Severe Sepsis and Septic Shock. NEJM 2001;345(19):1368-77.
  2. Annane D, et al. The Effect of Treatment with Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients with Septic Shock. JAMA 2002;288(7):862-71.
  3. Keh D, et al. Immunologic and Hemodynamic Effects of “Low-Dose” Hydrocortisone in Septic Shock. AJRCCM 2003;167:512-520.
  4. Landry DW and Oliver JA. Mechanisms of Disease: The Pathogenesis of Vasodilatory Shock [Review Article]. NEJM 2001(8);345:588-95.

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