![]() Pulmonary vascular obstruction (pulmonary embolism, venous air embolism, etc.) ![]() Impaired cardiac output due to pulmonary vascular or mechanical obstruction Pathologic vasodilatation leading to relative intravascular volume depletionĪnaphylactic (IgE mediated allergic reaction) Structural (valvular insufficiency, ventricular septal wall defect, etc.) Impaired cardiac output secondary to cardiac pump function, rhythm aberrancy or structural defectĪrrhythmogenic (brady- or tachydysrhythmia)Ĭardiomyopathic (myocardial infarction, heart failure, etc.) Non-hemorrhagic (vomiting, diarrhea, burns, etc.) Hemorrhagic (major trauma, gastrointestinal bleeding, ruptured ectopic pregnancy, etc.) While various categorizations for shock exist, a commonly utilized and clinically relevant categorization is depicted in the following table.ĭecreased intravascular volume resulting in decreased preload, stroke volume, and cardiac output The many causes of shock maybe categorized based on etiology. Initiation of intravenous fluid resuscitation is usually indicated, and is rarely harmful, to a patient in shock. FAST examination) can provide valuable information to narrow the differential diagnosis. An ECG and chest radiograph should generally be obtained. The patient should be placed on continuous telemetry, noninvasive blood pressure monitoring, and pulse oximetry. two large-bore IVs, intraosseous access, or central venous catheter) should be established. A rectal examination is often indicated to assess for melena or hematochezia. Particular attention should be directed to neck veins (± jugular venous distention), cardiopulmonary examination, abdominal examination, and extremity examination (± signs of hypoperfusion or abnormal vasodilatation). A rapid and accurate assessment of the airway, breathing, and circulation, followed by a focused history and physical examination should be performed. gunshot wound to the abdomen), while others may be undifferentiated. Some patients in shock present with a readily identifiable etiology (i.e. While circulatory failure and hypotension is the most common and readily identified clinical presentation of shock, the manifestations of shock exist along a continuum of illness severity, thus a patient with initially normal vital signs may still be in shock.Įarly recognition of shock and initiation of empiric treatment is of utmost importance. Shock may arise by impaired delivery of oxygen to tissues, impaired utilization of oxygen by tissues, increased oxygen consumption by tissues, or a combination of these processes. Shock is a pathophysiologic state in which the oxygen supply to body tissues inadequately meets metabolic demands, resulting in dysfunction of end-organs.
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