multi class comparison

Shock Types Comparison: Hypovolemic vs Cardiogenic vs Septic vs Anaphylactic vs Neurogenic

Five shock types all drop blood pressure, but the skin tells you the story: cold and dry, cold and wet, warm and flushed, or warm and bradycardic. Pick the wrong fluid strategy — bolus a cardiogenic patient or restrict a septic one — and you push the patient toward arrest.

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Comparison

Side-by-side5 compared
Comparevs
Dimension
Hypovolemic
Cardiogenic
Septic
Anaphylactic
Neurogenic
Pathophysiology & cause
  • ↓ preload from volume loss (hemorrhage, burns, GI)
  • Pump failure then ↓ cardiac output (MI, HF, dysrhythmia)
  • Infection then systemic vasodilation, leaky vessels
  • IgE histamine release then vasodilation (drug/food/venom)
  • Lost sympathetic tone then vasodilation (SCI above T6)
Skin, HR & hallmark
  • Cold, pale, clammy/diaphoretic
  • Flat neck veins, thirst
  • tachycardia
  • Cold, pale, clammy/diaphoretic
  • JVD, crackles, S3, pulmonary edema
  • Warm, flushed, bounding early
  • cool/mottled late
  • Fever or hypothermia, ↑ lactate
  • Warm, flushed, urticaria, angioedema
  • Stridor, wheeze, throat tightness
  • Warm, dry, pink below injury
  • ★BRADYCARDIA with hypotension (not tachy)
Hemodynamics & labs
  • ↓ CO, ↑ SVR
  • ↑ lactate, ↓ Hgb if hemorrhage
  • ↓ CO, ↑ SVR, ↑ PCWP
  • ↑ troponin/BNP
  • ↑ CO early/↓ late, ↓ SVR
  • lactate >2, +cultures
  • ↓ SVR
  • clinical dx, ↑ tryptase supports
  • ↓ CO, ↓ SVR
  • bradycardia despite hypotension
Nursing priorities
  • Control bleeding source first
  • Large-bore IV, rapid volume
  • Optimize pump
  • avoid fluid overload
  • Monitor ECG, hemodynamics, O2
  • Cultures then antibiotics ≤ 1 hr
  • Source control
  • serial lactates
  • Epinephrine FIRST
  • secure airway
  • Remove allergen
  • high-flow O2
  • Spinal immobilization, prevent hypothermia
  • Treat bradycardia + hypotension together
First-line treatment
  • Crystalloid bolus 1–2 L NS/LR
  • Blood products if hemorrhage
  • ★Inotropes (dobutamine)
  • avoid fluid overload
  • Reduce preload: diuretics, nitro if BP ok
  • ★30 mL/kg crystalloid within 3 hr
  • Norepinephrine if MAP < 65
  • ★IM epi 0.3–0.5 mg, anterolateral thigh — FIRST
  • Repeat q5–15 min
  • H1/H2, steroids adjunct
  • IV fluids, then phenylephrine
  • Atropine for symptomatic bradycardia
Teaching / prevention
  • Hydration, early bleeding signs
  • Cardiac risk control
  • med adherence
  • Early infection signs
  • complete antibiotics
  • Carry epi auto-injector
  • avoid trigger
  • Position changes slowly
  • fall safety
Red flags — escalate
  • MAP < 65 despite boluses then vasopressors
  • Worsening pulmonary edema, SpO2 drop
  • Lactate rising, MAP < 65 on fluids
  • Stridor or biphasic reaction return
  • HR < 40 with hypotension then atropine/pace
Complications
  • Organ hypoperfusion, AKI
  • Cardiac arrest, multiorgan failure
  • DIC, MODS, ARDS
  • Airway obstruction, cardiac arrest
  • Autonomic dysreflexia, hypothermia
Pathophysiology & cause

Hypovolemic

  • ↓ preload from volume loss (hemorrhage, burns, GI)

Cardiogenic

  • Pump failure then ↓ cardiac output (MI, HF, dysrhythmia)
Skin, HR & hallmark

Hypovolemic

  • Cold, pale, clammy/diaphoretic
  • Flat neck veins, thirst
  • tachycardia

Cardiogenic

  • Cold, pale, clammy/diaphoretic
  • JVD, crackles, S3, pulmonary edema
Hemodynamics & labs

Hypovolemic

  • ↓ CO, ↑ SVR
  • ↑ lactate, ↓ Hgb if hemorrhage

Cardiogenic

  • ↓ CO, ↑ SVR, ↑ PCWP
  • ↑ troponin/BNP
Nursing priorities

Hypovolemic

  • Control bleeding source first
  • Large-bore IV, rapid volume

Cardiogenic

  • Optimize pump
  • avoid fluid overload
  • Monitor ECG, hemodynamics, O2
First-line treatment

Hypovolemic

  • Crystalloid bolus 1–2 L NS/LR
  • Blood products if hemorrhage

Cardiogenic

  • ★Inotropes (dobutamine)
  • avoid fluid overload
  • Reduce preload: diuretics, nitro if BP ok
Teaching / prevention

Hypovolemic

  • Hydration, early bleeding signs

Cardiogenic

  • Cardiac risk control
  • med adherence
Red flags — escalate

Hypovolemic

  • MAP < 65 despite boluses then vasopressors

Cardiogenic

  • Worsening pulmonary edema, SpO2 drop
Complications

Hypovolemic

  • Organ hypoperfusion, AKI

Cardiogenic

  • Cardiac arrest, multiorgan failure

★ marks the fact that sets a column apart.

Clinical Pearl

Cold + dry = hypovolemic; cold + wet = cardiogenic; warm + tachy = septic; warm + brady = neurogenic.

Component Topics

Hypovolemic ShockCardiogenic ShockNeurogenic & Obstructive ShockAnaphylaxisSepsis

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