Chapter 25-7: Differential Diagnosis of Shock

Distributive shock

1. Septic shock

2. Hepatic failure

3. Pancreatitis

4. Anaphylactic shock

5. Adrenal insufficiency

6. Neurogenic shock

7. Arteriovenous shunts

Hypovolemic shock

1. Hemorrhage

   1. Trauma

   2. Gastrointestinal hemorrhage

   3. Postsurgical, postprocedural bleeding

   4. Intra-abdominal (eg, abdominal aortic aneurysm, ruptured ectopic pregnancy)

2. Volume depletion

   1. Vomiting

   2. Diarrhea

   3. Excessive diuresis (from diuretics or uncontrolled diabetes)

Cardiogenic shock

1. Poor contractility

   1. Left ventricular (LV) failure

      1. Myocardial infarction (MI)

      2. Myocarditis

      3. Metabolic derangements (eg, profound acidosis, hypophosphatemia, hypocalcemia)

      4. Depressant drugs (beta-blockers, calcium-channel blockers)

      5. Miscellaneous causes of heart failure (HF) (eg, alcoholic cardiomyopathy, adriamycin-related cardiomyopathy, dilated cardiomyopathy)

   2. Right ventricular (RV) failure

      1. MI

      2. Pulmonary vascular disease

      3. Hypoxic pulmonary vasoconstriction

2. Outflow obstruction

   1. Aortic stenosis

   2. Hypertrophic cardiomyopathy

   3. Malignant hypertension

   4. Pulmonary embolism (PE)

3. Arrhythmogenic

   1. Significant bradycardia

   2. Significant tachycardia

4. Backflow

   1. Acute mitral regurgitation – papillary muscle rupture or dysfunction

   2. Rupture septum or free wall

   3. Acute aortic regurgitation

5. Reduced filling

   1. Constrictive pericarditis

   2. Tamponade

   3. Tension pneumothorax

   4. Mitral stenosis