The science behind shock: Why providers must understand the RAAS

Ever wonder what really happens inside the body during shock? This week, Chris Cebollero and Kelly Grayson dive into the renin angiotensin aldosterone system (RAAS).  From vasoconstriction to fluid retention, they break down this complex topic with real-life examples, a sprinkle of humor and practical tips for how EMS providers can apply this knowledge in the field.

Kelly shares the importance of understanding the “why” behind shock presentations, from recognizing when fluids won’t work to knowing when vasopressors are the answer. With anecdotes like treating a sepsis patient on ACE inhibitors and using pulse ox waveforms for clues, this episode blends science with field-tested wisdom. Whether you’re an EMT, paramedic, or just an anatomy nerd, you’ll walk away with a clearer picture of how the RAAS keeps us alive – and how we, as EMS professionals, can work smarter alongside it.

Memorable quotes

• “It's called, ‘The Renan Angiotensin Aldosterone System – not just a planetary belt in Star Wars’”. — Kelly Grayson

• “So, the kidneys now say, ‘We're not getting enough blood. Here's this renin that we're gonna send out because we've gotta fix this problem.’ What the body doesn't know is that Chris Cebollero and Kelly Grayson and you are out there trying to fix it. So it’s trying to fix itself.” — Chris Cebollero

Related resources:

• Understanding push dose pressors

• Understanding prehospital vasopressors: Dopamine, epinephrine or norepinephrine?

• A basic overview of shock for EMS

• Compensated vs. decompensated shock: what you need to know

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