Critical Care Self-Study Resources-A Systematic Approach to Undifferentiated Shock: From POCUS to PACs!

Video Transcription

Video Summary

The use of minimally invasive or non-invasive cardiac output monitors to diagnose shock was discussed in a video presentation. The presenter highlighted the importance of accurately diagnosing shock and determining the type of shock in order to choose the appropriate intervention. The focus was on monitoring devices that can provide information on cardiac output or cardiac index. Various devices were evaluated based on their accuracy and preciseness, represented by the bias and the limit of agreement. Finger cuff plethysmography was described as a non-invasive method that uses a cuff on the finger to measure arterial pressure waveform. However, its accuracy and preciseness were found to have a wide range of error. Bi-reactance and bioimpedance were also explored as methods using electrical charges through the thorax to measure phase shift and determine cardiac output. Although these methods showed improvement in recent years, they still have a high bias. Another method discussed was pulse contour analysis, which uses an arterial line and a black box to calculate cardiac output based on pressure to volume change. However, this method also has a high bias and may require frequent calibration. Overall, the presenter emphasized the limitations and variability of these monitoring devices and expressed the need for more invasive methods if patients are not improving with non-invasive monitoring. The next speaker discussed the use of point-of-care ultrasound in diagnosing shock and the limitations of non-invasive methods. The speaker highlighted the accessibility and non-invasiveness of ultrasound, making it a useful tool in differentiating shock types. The abdominal cardiac evaluation of shock and rush protocols were mentioned as commonly used ultrasound approaches. These protocols involve cardiac, IVC, aorta, and other examinations to assess shock in patients. The speaker noted that ultrasound has shown to improve diagnostic recognition of shock, but its impact on patient outcomes is less clear. The presentation concluded by highlighting the importance of early diagnosis of shock and the need for standardizing the use of point-of-care ultrasound in clinical practice. The final speaker discussed the invasive approach to monitoring shock using arterial lines, central venous access, transpulmonary thermodilution, and pulmonary artery catheters. The different information that can be obtained from these devices, such as heart rate, mean arterial pressure, DPDT, and SAO2, was explained. The limitations and benefits of each device were discussed, as well as the evidence supporting the use of pulmonary artery catheters in managing shock. The speaker emphasized the need to use the device that answers the clinical question and to maximize the information obtained from the available screens and waveforms. The importance of timely diagnosis and appropriate use of invasive devices was also highlighted.

Meta Tag

Asset Type Video

Curriculum Category Pulmonary Disease in Critical Care

Speaker Casey Cable

Speaker Siddharth Dugar

Speaker Maxwell Hockstein

Speaker Matthew Siuba

Keywords

cardiac output monitors

diagnosing shock

non-invasive methods

point-of-care ultrasound

invasive approach

pulmonary artery catheters

timely diagnosis