1. PeaceHealth Southwest Hospital/Carson Tahoe Medical Center

2. Shock Defined

3. Cardiogenic Shock

4. Hypovolemic Shock

5. Obstructive Shock

6. Distributive Shock

7. Septic Shock

8. Post Cardiac Surgery Vasoplegia*

9. Emory Healthcare

10. Why Multimodal Shock Therapy?

11. Why Multimodal Shock Therapy?

12. Emory Healthcare Angiotensin II Protocol

13. Emory Healthcare Angiotensin II Protocol (cont)

14. Emory Healthcare Angiotensin II Protocol (cont)

15. The Emory Protocol

16. Emory Protocol Vasopressor Titration

17. Why This Protocol?

18. Issues With Protocol Implementation

19. George Washington University Hospital

20. Initial Assessment to Identify Type of Shock

21. Types of Shock

22. 2018 SSC Bundle Update Hour-1

23. Vasopressors to Reach MAP ≥ 65 mm Hg

24. Organ Support

25. Hypovolemic Shock

26. Obstructive Shock

27. Cardiogenic Shock

28. Vasopressors in Cardiogenic Shock

29. Mayo Clinic

30. Mayo Clinic Patients Admitted to ICU Clinical Characteristics

31. ICU Patients on Vasopressors

32. Vasopressor Utilization Index (VUI)

33. VUI to 2013

34. Changes of VUI Temporal Relationship With Clinical Trials

35. Use of Different Vasopressor Based on the ICU Type

36. Trends of Specific Vasopressor Use

37. Use of Low-Dose Dopamine Dopamine Dose < 3 mcg/kg/min

38. Mayo Clinic Approach to Vasopressor Utilization: Steps to Be Taken Before Using Angiotensin II

39. 1. Defining Refractory Distributive Shock

40. 2. Ruling Out Cardiogenic Shock

41. 3. Dose & Titration

42. 4. Weaning Angiotensin II

43. Abbreviations

44. Abbreviations (cont)