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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Side-by-side5 compared
Focus
Comparevs
Dimension
Hypovolemic
Cardiogenic
Septic
Anaphylactic
Neurogenic
Pathophysiology & cause
- ↓ Preload from volume loss
- Pump failure (MI, HF, dysrhythmia)
- Infection: vasodilation + capillary leak
- IgE histamine release (food/drug/venom)
- Lost sympathetic tone (SCI T6 or above)
Skin, HR & hallmark
- Cold, pale, clammy/diaphoretic
- Flat neck veins, thirst
- Tachycardia
- Cold, pale, clammy/diaphoretic
- JVD, crackles, S3, pulmonary edema
- Tachycardia
- Warm, flushed, bounding early
- Cool, mottled late
- Fever or hypothermia, ↑ lactate
- Tachycardia
- Warm, flushed, urticaria, angioedema
- Stridor, wheeze, throat tightness
- Tachycardia
- Warm, dry, pink below injury
- ★Bradycardia + hypotension
Hemodynamics & labs
- ↓ CO, ↑ SVR, ↓ PCWP
- ↓ Hgb/Hct if hemorrhage
- ↓ CO, ↑ SVR, ↑ PCWP
- ↑ troponin/BNP
- ↑ CO early, ↓ CO late
- Lactate > 2, + blood cultures
- ↓ SVR (vasodilation)
- ↓ SVR (vasodilation)
- ↑ Tryptase supports dx
- ↓ SVR (vasodilation)
- ↓ CO from bradycardia, pooling
Nursing priorities
- Control bleeding source first
- 2 large-bore IVs
- Optimize pump, ↓ cardiac workload
- Avoid fluid overload
- Cultures before antibiotics (≤ 1 hr)
- Infection source control
- Serial lactates
- Epinephrine FIRST
- Secure airway
- Remove allergen
- Spinal immobilization
- Treat bradycardia and hypotension
- Prevent hypothermia
First-line treatment
- Replace losses: fluids or blood
- Blood products if hemorrhage
- ★Inotropes (dobutamine)
- Diuretics, nitrates if BP allows
- ★30 mL/kg crystalloid within 3 hr
- Norepinephrine if MAP < 65
- ★IM epi 0.3–0.5 mg, anterolateral thigh
- Repeat epi q5–15 min if needed
- Antihistamines, steroids = adjuncts
- Vasopressor to keep MAP 85–90
- Atropine for symptomatic bradycardia
Teaching / prevention
- Hydration, early bleeding signs
- Cardiac risk control
- Early infection signs
- Complete antibiotics
- Carry epi auto-injector
- Avoid known trigger
- Change position slowly
Red flags — escalate
- Ongoing blood loss despite volume
- Worsening pulmonary edema, SpO2 drop
- Rising lactate, MAP < 65 on fluids
- Stridor or biphasic reaction
- Severe brady (HR < 40) + hypotension
Complications
- Lethal triad if hemorrhage
- Multiorgan failure (MODS)
- Lethal dysrhythmias
- Multiorgan failure (MODS)
- DIC, ARDS
- Multiorgan failure (MODS)
- Airway obstruction (angioedema)
- Multiorgan failure (MODS)
- Autonomic dysreflexia (later)
- Hypothermia (poikilothermia)
- Multiorgan failure (MODS)
Pathophysiology & cause
Hypovolemic
- ↓ Preload from volume loss
Cardiogenic
- Pump failure (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
- Tachycardia
Hemodynamics & labs
Hypovolemic
- ↓ CO, ↑ SVR, ↓ PCWP
- ↓ Hgb/Hct if hemorrhage
Cardiogenic
- ↓ CO, ↑ SVR, ↑ PCWP
- ↑ troponin/BNP
Nursing priorities
Hypovolemic
- Control bleeding source first
- 2 large-bore IVs
Cardiogenic
- Optimize pump, ↓ cardiac workload
- Avoid fluid overload
First-line treatment
Hypovolemic
- Replace losses: fluids or blood
- Blood products if hemorrhage
Cardiogenic
- ★Inotropes (dobutamine)
- Diuretics, nitrates if BP allows
Teaching / prevention
Hypovolemic
- Hydration, early bleeding signs
Cardiogenic
- Cardiac risk control
Red flags — escalate
Hypovolemic
- Ongoing blood loss despite volume
Cardiogenic
- Worsening pulmonary edema, SpO2 drop
Complications
Hypovolemic
- Lethal triad if hemorrhage
- Multiorgan failure (MODS)
Cardiogenic
- Lethal dysrhythmias
- Multiorgan failure (MODS)
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Clinical Pearl
Cold + dry = hypovolemic; cold + wet = cardiogenic; warm + tachy = septic; warm + brady = neurogenic.
Component Topics
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