Should we teach / use the Shock Index?

[DwayneEMTP]

Perfusion is actually quite difficult and certain aspects are ill defined. Remember, one of the greatest unsolved problems today is how to derive the Navier Stokes equations from first principles and really develop a sound understanding of concepts such as turbulent flow. Being that we have areas in our body where Reynolds numbers are high, we have turbulence. This is one of many things we do not fully understand.

Damn it! I had just typed that exact thing but you beat me to it!

Sometimes life's just not fair....

(Ok, so it's possible it wasn't EXACTLY the same...)

[Kiwiology]

Sometimes life's just not fair....

Correct, nobody likes putting up with you

[Bieber]

Never having heard of it before today, I'm a bit skeptical about its usefulness.

[mobey]

Damn Asys beat me too it.

I think MAP (if using LP12-15) is a way better tool.

It is important that students understand systolic is a representation of preload, diastolic is a representation of vascular resistance, and a MAP of 60 is needed to perfuse the vital organs.

When giving fluids/pressors, I use MAP and signs of perfusion, not BP.

If I were to do any "above and beyond" training, it would be that.

[Kaisu]

I have to totally agree with mobey and am just sorry I didn't think of it first. MAP is something I learned to use when I ran CCT. That is something that is not obtainable with a manual BP (as far as I know, and may be corrected once again - thank you smart people,) It should be taught as part of the vital signs. It's easy and furthers the concept much more effectively than the stroke scale IMHO,

PS.. I'm not sure I agree that the magic number is 60. Like everything else in medicine, it is highly individualistic. I have seen patients with MAP of 50 doing just fine.

edited to add ps

Edited April 28, 2012 by CrapMagnet

[paramedicmike]

Well, you can determine what the MAP is if you have a manual BP:

[(2 x diastolic)+systolic] / 3

[Kaisu]

I knew it... thank you smart person

[paramedicmike]

I knew it... thank you smart person

My friend, if you only knew how hilariously incorrect that statement is.

Thank you for the laugh. I needed that today.

[Bieber]

I agree with Mobey, I prefer MAP.

[DwayneEMTP]

"Conclusion: The SI can be a valuable tool, raising suspicion when it is abnormal even when other parameters are not, but is far too insensitive for use as a screening device to rule out disease. A normal SI should not lower the suspicion of major injury." (Journal of European Emergency Medicine, 2011)

http://journals.lww....ntiating.8.aspx

A Google search seemed to show that though no one here finds any value in it that physician level medicine seemed to take it at least halfway seriously for more than a little while.

I'm surprised, particularly in this group, that so many were willing to say "I don't really get it, but I'm willing to say that it's no good, particularly when compared to X." "I don't really know how Amiodarone works, but Lido is sure as hell a better option, I'll tell you that."

If you don't understand an idea, one that I've found listed on many physician level sites and in many scientific journals, how then do you decide it's relative prehospital value and then even compare it to something else?

I long for the days at the City where this idea would have had the entire thread trying to figure out why it might work, and/or intelligently proving and explaining exactly why it might not work instead of saying, "Meh...It's probably nothing..." Or at least understanding it enough to be able to intelligently compare it to something else. My guess would be that in most cases of 'the unknown v. the familiar' that familiar is a hands down winner.

Unless the unknown is easier and/or looks more macho when being performed.

I'm curious, to those that claimed that MAP is a more valuable tool, without Googling, can you explain the value that some have attributed to SI, and in what areas they have found it? What are the relative strengths and weaknesses that were discovered in those areas? And if you can't do so, how can you make an intelligent comparison to MAP, or anything else for that matter?

I spent about an hour this morning looking into it and though I still don't really get it there seems to be significant interest in it in diverse areas by folks way above our pay grade.

Just sayin'...