Ep 290 - Shock with Rich Carden at Trauma 2030

Shock fundamentally represents a failure in oxygen delivery and utilization at the cellular level, rather than merely a drop in blood pressure. While blood pressure serves as a convenient clinical surrogate, it often masks the underlying complexity of tissue hypoperfusion and metabolic homeostatic failure. Trauma patients frequently experience a dynamic, multi-stage progression through hemorrhagic, inflammatory, and distributive shock, necessitating a shift from simple pressure-based resuscitation to a focus on restoring systemic perfusion. Early, aggressive implementation of damage control resuscitation—including hemorrhage control, blood product administration, and the correction of coagulopathy—remains the most effective strategy to minimize the "dose" of shock. Avoiding premature use of vasopressors is critical, as these agents can exacerbate endothelial damage and glycocalyx shedding, ultimately worsening microvascular circulation and long-term patient outcomes.