Approach to the patient with undifferentiated hypotension or shock: Ongoing resuscitation

ABG: arterial blood gas; CBC: complete blood count; CO: cardiac output; CT: computed tomography; CTPA: computed tomographic pulmonary angiography; CXR: chest radiograph; DIC: disseminated intravascular coagulation; ECG: electrocardiography; IVC: inferior vena cava; JVD: jugular venous distension; LV: left ventricle; P2: pulmonic second heart sound; PAC: pulmonary artery catheter; Pcwp: pulmonary capillary wedge pressure; PE: pulmonary embolus; RV: right ventricle; SvO₂: mixed venous oxyhemoglobin saturation; SVR: systemic vascular resistance.

* Timing and availability depends on institutional resources. Point-of-care ultrasonography may also be used in those in whom routine imaging is unsafe.

¶ Myocardial contractility may be depressed in some forms of distributive shock.

Δ The presence of B lines on lung ultrasound may suggest pulmonary edema to support cardiogenic shock.

◊ Detection of fluid in the peritoneal cavity and an aortic aneurysm may support hemorrhagic shock from aneurysm rupture.

§ Absence of lung sliding may support obstructive shock from tension pneumothorax.

¥ These findings are typical of PE, pulmonary hypertension, and tension pneumothorax. In cardiac tamponade, PAC reading are similar to those in cardiogenic shock; however, right atrial, right ventricular end-diastolic, and pulmonary artery wedge pressures are equal.