الفهرس 
Types of ShockOnly 14 pages are availabe for public view
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Abstract
Abstract
Introduction: Shock is a state of cellular and tissue hypoxia due to reduced oxygen delivery and/or
increased oxygen consumption or inadequate oxygen utilization. This most commonly occurs when
there is circulatory failure manifested as hypotension (ie.,reduced tissue perfusion). Shock is initially
reversible, but must be recognized and treated immediately to prevent progression to irreversible
organ dysfunction.
Aim of work: To clarify the recent updates in diagnosis and management of refractory shock in the
intensive care unit.
Objectives: To highlight pathogenesis of Refractory cardiogenic ,distributive ,hypovolemic and
obstructive shock, and Recent updates in diagnosis and treatment of each type .
Data source: Medline database (PubMed .,Medscape , Science Direct , EM-Portal)and all material
available on internet till 2017.
Conclusion : Recent updates in refractory shock includes the vasopressor levosimendan in
combination with noradrenaline, Growing evidence supporting ECMO as a new interventional tool
to improve the prognosis. Impella 2.5 is associated with significant early survival benefit. New
method s for monitoring those patients should include macrocirculatory and microcirculatory
parameters. One of the most important landmarks in 2016 was the publication of the new edition of
the Surviving Sepsis Campaign guidelines