Emergency physicians and scientists are continuously trying to find new methods to recognize shock at an earlier stage and initiate early treatment. With the evolving treatment and management of shock, the mortality remains high. The presentation of shock may be obvious as in a patient with the ultimate shock state, cardiac arrest or mildly as in the patient with decompensated cardiac failure. Patients can present with hypovolemic, cardiogenic, anaphylactic, neurogenic or even septicemic shock. Shock with hypotension is the main presentation of many diseases to the emergency department (ED). The use of ETCO 2 in the ED has great potential to be used as a method of non-invasive monitoring of patients in shock. However, normal ETCO 2 does not ensure patient survival. All patients who had ETCO 2 ≤ 12mmHg died in the ED. Early ETCO 2 measurements were found to be significantly lower in patients who did not survive to hospital admission ( p = 0.005). ETCO 2 on arrival was positively correlated with systolic and diastolic BP, MAP, bicarbonate, base excess and lactate when analyzed in all shock patients. Average ETCO 2 for patients in hypovolemic, cardiogenic and septic shock was 29.64 ± 11.49, 28.60 ± 9.87 and 27.81 ± 7.39 mmHg, respectively. Mean ETCO 2 for all patients on arrival was 29.07 ± 9.96 mmHg. Patient survival up to hospital admission and at 30 days was recorded. All patients were managed according to standard protocols and treatment regimes. Blood gases and serum lactate levels were obtained on arrival. Vital signs and ETCO 2 were measured on presentation and at 30-min intervals up to 120 min. They were grouped according to different types of shock, hypovolemic, cardiogenic, septic and others. One hundred three adults in shock with hypotension presenting to the ED were recruited into the study. This was a prospective observational study in a tertiary ED. The aim of this study was to determine the usefulness of end tidal carbon dioxide (ETCO 2) monitoring in hypotensive shock patients presenting to the ED.
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