Approach to Undifferentiated Shock - OnePager Summary
Shock occurs when there is inadequate blood flow (CO) & oxygen delivery (D02) to meet demands. Manifestations can be protean and may not initially include hypotension (cryptic shock). Identifying the etiology of undifferentiated shock is essential to determine treatment.
Shock can be broken into 4 categories: cardiogenic, obstructive, distributive, hypovolemic
Pump Problem (↓ CO):
 • CARDIOGENIC: Rate/Rhythm (bradycardia, VF etc), RV Failure (PE, PHTN), LV Failure (MI, myocarditis, etc), Valves (wide open MR, cordae tendenae rupture, etc), Toxins (CCB, BB, BRASH syndrome etc), Trauma (myocardial contusion)
 • OBSTRUCTIVE: Tension Pneumothorax, Cardiac Tamponade, Pulmonary Embolism, Outflow Obstruction (HOCM, critical AS), Dynamic Hyperinflation (auto-PEEP)
Pipes Problem (↓ SVR):
 • DISTRIBUTIVE:  Sepsis (may develop low CO later), Anaphylaxis, Inflammatory (SIRS, pancreatitis, post-cardiac arrest, amniotic or fat embolism, cytokine release syndrome), Neurogenic (SCI, severe TBI, effect of neuraxial anesthesia), Liver Failure, Endocrine (adrenal insufficiency, thyrotoxicosis), Medications (anesthesia, sedation)
Tank Problem (↓ Preload):
 • HYPOVOLEMIC: Hemorrhage (trauma, surgical, GIB), Skin Losses (bums, heat stroke, etc), Third-Spacing Volume Loss (pancreatitis, low albumin, trauma), Renal Losses(salt-wasting, hypoaldo, osmotic diuresis, diuretics), Low PO Intake

by Nick Mark MD @nickmmark

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