Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 3 2021

Obstructive Shock

  • Snapshot
    • A 35-year-old woman presents to the emergency room with shortness of breath. She reports that she has had shortness of breath on exertion for a few weeks, which has progressively worsened. She also reports some chest pain. She has a history of breast cancer and is now post-chemotherapy and radiation therapy. Her blood pressure is 83/54 mmHg, pulse is 110/min, and respirations are 24/min. On physical exam, she has jugular venous distention, delayed capillary refill, and faint peripheral pulses. Her skin is cold and clammy. (Constrictive pericarditis)
  • Introduction
    • Clinical definition
      • shock secondary to extra-cardiac causes of pump failure
  • Etiology
    • Pulmonary vascular
      • associated with right ventricular failure
      • pulmonary embolism
      • severe pulmonary hypertension
    • Mechanical
      • tension pneumothorax
      • pericardial tamponade
      • constrictive pericarditis
      • restrictive cardiomyopathy
    • Pathogenesis
      • general concept
        • an underlying extra-cardiac event or process causes a cardiac outflow obstruction, resulting in ↓ cardiac output (CO)
        • ↓ CO results in compensatory ↑ systemic vascular resistance (SVR)
      • pulmonary vascular causes
        • ↑ pulmonary vascular resistance > right ventricular pressure
      • mechanical causes
        • ↓ preload and inadequate right ventricular filling
          • often presents like hypovolemic shock
  • Presentation
    • Symptoms
      • typically present with features of the underlying cause (e.g., pleuritic chest pain in pulmonary embolism)
    • Physical exam
      • hypotension
      • tachycardia
      • jugular venous distention
      • cold and clammy skin
  • Imaging
    • Echocardiography
      • indications
        • to detect underlying causes, such as pericardial tamponade
  • Studies
    • Pulmonary artery catheterization
      • findings
        • ↓ pulmonary capillary wedge pressure (PCWP < 15 mmHg) in most cases
        • ↑ PCWP in cardiac tamponade
        • normal or ↓ CO as severity progresses
        • ↑ SVR
    • Making the diagnosis
      • most cases are clinically diagnosed
  • Differential
    • Different Types of Shock
      Shock TypeSkin

      Wedge Pressure (PCWP) (Preload)

      Systemic Vascular Resistance (SVR) (Afterload)
      Cardiac Output
      Hyovolemic Cold and clammy skin ↓↓
      Obstructive ↑ or ↓ ↔ or ↓
      Distributive Warm or dry skin ↔ or ↓ ↓↓ ↓ or ↑
  • Treatment
    • Management approach
      • treat underlying cause
  • Complications
    • Death
    • Acute renal failure
1 of 0
1 of 1
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options