Version May 2024
| Differential | Clinical features | Diagnostic testing/findings |
| Acute pulmonary embolism | Sudden onset dyspnea, pleuritic chest pain, hemoptysis, VTE risk factors other than pregnancy (eg, previous or current history). Chest radiograph normal. | Rarely, thrombus is seen on bedside echocardiography. PE should be evident on CTPA to distinguish PE from AFE once the patient is stable. While V/Q scan may also be diagnostic in pregnant women, it is not the optimal test in patients with life-threatening shock. |
| Anaphylaxis | Sudden onset hypotension with evidence of allergy (eg, lip and oropharyngeal swelling, inspiratory stridor, hives), agent known to induce anaphylaxis. DIC unlikely. | Clinical diagnosis. Diagnosis is retrospectively supported by documentation of elevated concentrations of serum or plasma total tryptase or plasma histamine. |
| Septic shock | Suspected source, onset unlikely to be sudden, fever, leukocytosis with left shift, coexistent hypovolemia. | Clinical diagnosis. Diagnosis may be retrospectively supported by culture results and response to antibiotics. |
| Cardiogenic shock | Crushing anterior chest pain, known diagnosis of cardiomyopathy, risk factors for ischemic heart disease or arrhythmia. DIC unusual, echocardiography may reveal regional wall motion abnormality, a pericardial effusion, or valve rupture. | Diagnosis may be supported by specific findings on echocardiography and electrocardiography. Rarely, a pulmonary arterial catheter or coronary vascularization is required (once the patient is stable). |
| Obstetric hemorrhagic shock | Signs and symptoms depend on the cause (eg, placenta previa, abruption, uterine atony, uterine rupture, genital tract laceration), but severe vaginal bleeding is the cardinal finding in most patients. Coagulopathy often follows hemorrhage. | Clinical diagnosis. Placenta previa is diagnosed by ultrasound showing that the placenta covers the internal cervical os. Bleeding from placental abruption begins before delivery, and may continue postpartum. Bleeding from uterine rupture may occur before or after delivery, depending on the timing of the rupture. |
| Anesthetic shock | History of local, spinal, or general anesthesia. DIC rare. | Clinical diagnosis. May be confirmed retrospectively by resolution of shock upon withdrawal of anesthetic agents. |
| Air embolism | History of instrumentation (eg, cesarean delivery, central line placement) and can be distinguished by visualization of air on imaging (although air rapidly dissipates on imaging. | Clinical diagnosis but in rare cases the demonstration of air in the intravascular space or organs in a patient with a known risk factor for air embolism is diagnostic. |
| DIC due to causes other than AFE | History of precipitating reason for DIC may be evident including trauma, transfusion, preeclampsia, retained dead fetus, and acute fatty liver of pregnancy. | Clinical laboratory diagnosis. |
| Hypoxemic respiratory failure | ARDS is slow in onset and is associated with bilateral infiltrates. Aspiration may be witnessed but radiograph abnormalities are typically late. | Clinical diagnoses that are often retrospective and dependent upon the identification of precipitating etiologies. |
| Seizures | Seizures may be due to eclampsia or anesthetic medications. | Clinical diagnosis. EEG may be necessary once the patients stabilizes following resuscitation. |
| Rare causes (aortic dissection, cholesterol embolism, tension pneumothorax) | Precipitating symptoms, conditions or events may be evident including back or chest pain (aortic dissection), known atherosclerosis or vascular manipulation (cholesterol embolism), pleuritic chest pain, tracheal deviation, absent breath sounds, known risk factor such as cystic lung disease (pneumothorax). | Bedside echocardiography and lung ultrasound may rarely be diagnostic in patients with aortic dissection and tension pneumothorax, respectively. Cholesterol embolism is generally a clinical diagnosis but may be supported with vascular imaging. |
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