ABSTRACT
Shock is recognized at the bedside when hemodynamic instability leads to evidence of hypoperfusion of several organ systems. Accordingly, shock is a clinical diagnosis. Successful management of shock requires a primary survey directed at urgent initial resuscitation, which confirms or changes the working diagnosis, followed by a pause to ponder the broader differential diagnosis of the types of shock and the pathophysiology of shock, which leads to early definitive therapy of the underlying cause of shock. Shock has a hemodynamic component, which is the initial focus of resuscitation, but shock also has a systemic inflammatory component that leads to multiple system organ failure. Invasive hemodynamic monitoring should be goal-directed and discontinued as early as possible. Throughout this chapter, the importance of the tempo of resuscitation is emphasized.
