Review Question - QID 210695

This patient with low blood pressure, dramatically decreased pulmonary capillary wedge pressure, and increased systemic vascular resistance most likely has hypovolemic shock that could be treated directly by fluid resuscitation.

Shock is caused by decreased oxygen delivery that is insufficient to meet oxygen utilization demands and results in cellular and tissue hypoxia. There are 4 major types of shock depending on the mechanism by which tissue perfusion and blood pressure are compromised. These types are cardiogenic (a heart pump defect), hypovolemic (a vascular volume problem), distributive (a peripheral resistance problem), and obstructive (an extracardiac forward flow problem). These etiologies can be distinguished by clinical history or by specialized tests such as pulmonary capillary wedge pressure and systemic vascular resistance.

Incorrect Answers:
Answer 1: Antibiotic administration would target septic shock; however, septic shock would present with a decreased systemic vascular resistance.

Answer 3: Intravenous ionotropes would target cardiogenic shock; however, cardiogenic shock would dramatically decrease cardiac output with a milder decrease in pulmonary capillary wedge pressure.

Answer 4: Relieving obstruction would target obstructive shock; however obstructive shock would dramatically decrease cardiac output with a milder decrease in pulmonary capillary wedge pressure.

Answer 5: Vasopressors would target distributive shock; however, distributive shock would present with a decreased systemic vascular resistance.

Bullet Summary:
Hypovolemic shock presents with dramatically decreased pulmonary capillary wedge pressure, increased systemic vascular resistance, and mildly decreased cardiac output.