Shock is a common condition that emergency department clinicians must be experts in treating. It's easy, however, to overlook the presence of shock in patients who initially look well or have seemingly normal systolic blood pressure (SBP), and the result can be deadly.
The following is a list of top 5 pitfalls in managing shock, based on 25 years of personal experience in clinical care and medical malpractice consultation work.
1. Failure to consider the differential diagnosis of shock
Shock has multiple causes, but it is easy to focus only on the most common ones, such as hypovolemia and sepsis, and forget about less common but critically important ones such as anaphylaxis and adrenal crisis. I have often found it helpful to use a mnemonic to remember a differential diagnosis for causes of shock:
SHOCK'D:
Septic, spinal (neurogenic)
Hypovolemic, hemorrhagic
Obstructive (pulmonary embolism, tension pneumothorax, tamponade)
Cardiogenic, compartment syndrome (abdominal)
K: Anaphyla'k'tic, endo'k'rine
Drugs
Providers should always consider the full differential of the etiologies before settling on a diagnosis and treatment plan.
2. Overreliance on SBP rather than mean arterial pressure
It is important to remember that we live only one third of our life in systole but two thirds in diastole; therefore, diastolic blood pressure (DBP) in many respects is a better marker of vital organ perfusion than SBP.
