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.
Comparison
Side-by-side5 compared
Comparevs
Dimension
Hypovolemic
Cardiogenic
Septic
Anaphylactic
Neurogenic
Pathophysiology & cause
- ↓ preload from volume loss (hemorrhage, burns, GI)
- Pump failure → ↓ cardiac output (MI, HF, dysrhythmia)
- Infection → systemic vasodilation, leaky vessels
- IgE histamine release → vasodilation (drug/food/venom)
- Lost sympathetic tone → 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 → vasopressors
- Worsening pulmonary edema, SpO2 drop
- Lactate rising, MAP < 65 on fluids
- Stridor or biphasic reaction return
- HR < 40 with hypotension → 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 → ↓ 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 → 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.
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