Kritikus brings an emphasis to “back to basics” in training health care professionals to recognize earlier and rapidly treat at-risk patients. this approach has dramatically decreased mortality in patients with both septic, hypovolemic shock and acute respiratory failure by developing a complete system of care for these patients, predicated on keeping it simple and execution.
Unreversed Shock is 100% fatal. if not recognized in its earliest stages it often leads to multi-organ failure and long hospital stays. Utilizing a four-arm system of care for recognition and treatment of shock patients can further improve outcomes
Shock is a syndrome of inadequate tissue perfusion. If it is not recognized and treated during a narrow window of opportunity, critical tissue hypoxia develops, and initiates a cascade of events leading to multiple organ failure and death. The estimated mortality rate in patients with cardiogenic shock with acute myocardial infarction ranges from 50 to 80%.3 in patients with septic shock, the mortality rate varies from 30% to 50% . Even with major advances in the therapeutic armamentarium, septic shock alone has been estimated to claim at least 90,000 lives per year in the United States. Despite the high incidence and mortality rate of shock, a comprehensive systems-based approach to rapidly identify and treat shock has been slow to evolve.
A team approach to the resuscitation of patients with shock was first described in 1967. This concept reemerged as the medical emergency team, a group of physicians and nurses that can be activated by frontline non-physician providers to immediately evaluate and treat patients with significant alterations in vital signs or neurologic deterioration. This approach led to decreases in the incidence of in-hospital cardiac arrest, bed occupancy of cardiac arrest survivors, and the overall in-hospital mortality rate. A similar approach has proved especially beneficial to the subset of patients with shock whether in the hospital or in the field. In addition, early goal-directed hemodynamic therapy has been shown to reduce mortality in patients undergoing high-risk surgery, and those who have experienced trauma, severe sepsis, and septic shock. However, studies of goal-directed therapy that were initiated later in the course of critical illness have yielded disappointing results.
These observations suggest that the resuscitation of shock patients is more likely to improve survival if it is instituted early in the disease process. However, the appropriate resuscitation of shock patients is often hampered by a lack of recognition of early clinical decline and inadequate knowledge, experience, and skills of healthcare providers, which results in avoidable delays in appropriate treatment and patient transfer to the ICU. The above factors are remedied with a systems-based team approach incorporating staff education to enhance early recognition, empowerment of non-physicians to mobilize hospital resources, rapid protocol-directed therapy, early intensivist involvement, and a dedicated shock bed to allow prompt transfer to the ICU.1,23–33. This multidisciplinary, point-of-care-driven approach to the treatment of shock has reduce the time to treatment with resultant decrease in mortality.