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Shock Resident Survival Guide Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, MBChB. [2]

Synonyms and keywords: Circulatory shock

Overview

Shock is the syndrome of circulatory failure that results in inadequate cellular oxygen utilization. The diagnosis of shock is based on clinical signs and biochemical abnormalities indicative of tissue hypoperfusion.

Causes

Life Threatening Causes

Shock is a life-threatening condition and must be treated as such irrespective of the underlying cause.

Common Causes

• Cardiogenic shock

• Arrhythmic

• Sinoatrial block
• Atrioventricular block
• Ventricular tachycardia
• Supraventricular tachycardia

• Mechanical

• Hypertrophic cardiomyopathy
• Acute mitral regurgitation
• Ventricular septal defect

• Myocardial

• Cardiomyopathy
• Myocardial contusion
• Myocardial infarction
• Myocarditis
• Postischemic myocardial stunning
• Septic myocardial depression

• Pharmacologic

• Anthracycline
• Calcium channel blockers

• Obstructive shock

• Decreased cardiac compliance

• Cardiac tamponade
• Constrictive pericarditis

• Decreased ventricular preload

• Intrathoracic tumor
• Mechanical ventilation with positive end-expiratory pressure (PEEP)
• Tension pneumothorax

• Increased ventricular afterload

• Aortic dissection
• Pulmonary embolism
• Acute pulmonary hypertension

• Hypovolemic shock

• Fluid depletion

• Dehydration
• Diarrhea
• Polyuria
• Vomiting

• Hemorrhage

• Gastrointestinal bleeding
• Retroperitoneal hemorrhage
• Trauma

• Distributive shock

• Sepsis
• Toxic shock syndrome
• Anaphylactic or anaphylactoid reaction
• Neurogenic shock
• Endocrinologic

• Adrenal crisis
• Thyroid storm

Click here for the complete list of causes.

FIRE: Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) as shown below should be performed to identify patients in need of immediate intervention.

Boxes in red signify that an urgent management is needed.

Complete Diagnostic Approach

Treatment

Do's

Don'ts

References

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