The clinical presentation and the presumptive etiology of shock will dictate the use of ancillary studies. A battery of standard hematologic, coagulation, and biochemical tests usually provides an assessment of a patient's general physiologic condition and occasionally detects an abnormality that requires specific treatment (T.ab!e,.2.6-4). A wide range of laboratory abnormalities may be encountered in shock, but most abnormal values merely point to the particular organ system that is either contributing to or being affected by the shock state. No single laboratory value is sensitive or specific for shock.
Hemodynamic monitoring is important in the assessment of patients in shock and following response to treatment. Monitoring capabilities will vary from institution to institution, but basic capabilities should include electrocardiographic monitoring, continuous noninvasive but preferably intraarterial blood pressure monitoring, pulse oximetry, end-tidal CO2 monitoring, and CVP monitoring.
A variety of tubes and catheters are used to monitor patients or prevent complications: nasogastric tube, continuous rectal or esophageal temperature, and bladder catheterization. A pulmonary artery catheter, although impractical in the ED, is useful in monitoring mixed venous oxygen saturation, cardiac output, and left ventricular filling pressure. The benefit of monitoring patients with a pulmonary artery catheter is subject to debate. 13 Because hemodynamic measurements are physiologic values, they should be used to answer specific physiologic questions rather than to serve as end points themselves.
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