The Surgical clinics of North America
-
In critically ill patients there is frequently more than one problem, which may not be obvious, contributing to the shock state. The history, physical exam, and monitoring devices may not be reliable individually, but must be considered together and interpreted in the light of the pathophysiologic mechanisms involved. A plan for monitoring and treating critically ill patients is outlined. The advantages and limitations of various monitoring techniques are discussed.
-
The effective use of vasoactive drugs in shock requires an understanding of the pathophysiologic mechanisms involved in the various types and stages of shock and knowledge of the specific pharmacologic effects of each drug in the abnormal state. Vasoactive drugs should be used after the primary and secondary causes of shock have been corrected. Specific vasoactive drugs should be selected on the basis of measured hemodynamic abnormalities.