Overview Different Types of Shock Shock Type Skin Wedge Pressure (PCWP) (Preload) Systemic Vascular Resistance (SVR) (Afterload) Cardiac Output Hypovolemic Cold and clammy skin ↓↓ ↑ ↓ Cardiogenic Cold and clammy skin ↑ or ↓ ↑ ↓↓ Obstructive Cold and clammy skin ↑ or ↓ ↑ ↓↓ Distributive Warm or dry skin ↓ ↓↓ ↓ (dry)↑ (warm) Introduction Clinical definition decreased oxygen delivery, increased oxygen consumption, or impaired oxygen utilization that results in cellular and tissue hypoxia this occurs in cases of reduced tissue perfusion (e.g., hemorrhage) there are 4 types of shock login to view 4 more bullets Cardiogenic Clinical definition shock secondary to intracardiac causes results in a decreased cardiac output self-perpetuating since login to view 4 more bullets Etiology causes of cardiogenic shock can be divided into three categories cardiomyopic login to view 5 more bullets arrhythmic login to view 2 more bullets mechanical login to view 2 more bullets Clinical findings cold and clammy skin Treatment intravenous inotropes (e.g., dobutamine) intra-aortic balloon pump in certain cases percutaneous left ventricular assist device (LVAD) in cases where more extensive and prolonged support is needed to achieve hemodynamic stability Hypovolemic Clinical definition shock secondary to reduced intravascular volume the reduced preload results in a decreased cardiac output Etiology causes of hypovolemic shock can be divided into hemorrhagic (e.g., trauma and gastrointestinal bleeding) non-hemorrhagic login to view 3 more bullets Clinical findings cold and clammy skin Treatment intravenous fluids Distributive Clinical definition shock secondary to severe peripheral vasodilation Etiology septic shock presents with decreased vasopressin levels non-septic causes include systemic inflammatory response syndrome (SIRS) neurogenic shock (e.g., traumatic brain and spinal cord injury and neuro-axial anesthesia) anaphylaxis Clinical findings warm or dry skin Treatment intravenous fluids and vasopressors in patients with septic shock and hypotension refractory to fluids and vasopressors, adrenal insufficiency should be suspected and treated empirically with hydrocortisone Obstructive Clinical definition shock secondary to extracardiac causes of pump failure (most common) typically is associated with impaired right ventricular output Etiology causes of obstructive shock can be divided into pulmonary vascular (e.g., severe pulmonary embolism and pulmonary hypertension) mechanical (e.g., tension pneumothorax, pericardial tamponade, and constrictive pericarditis Clinical findings cold and clammy skin Treatment manage the obstruction