| Distributive | Septic | - Gram positive (Pneumococcus, Staphylococcus, Streptococcus, Enterococcus, Listeria)
- Gram negative (Klebsiella, Pseudomonas, Escherichia, Haemophilus, Legionella, Neisseria, Moraxella, Rickettsia, Francisella [tularemia])
- Fungal (Candida, Aspergillus)
- Viral (influenza, cytomegalovirus, Ebola, varicella)
- Parasitic (Plasmodium, Ascaris, Babesia)
- Mycobacterium (Mycobacterium tuberculosis, Mycobacterium abscessus)
|
| Non-septic | - Inflammatory shock (systemic inflammatory response syndrome) – Burns, trauma, pancreatitis, postmyocardial infarction, post coronary bypass, post cardiac arrest, viscus perforation, amniotic fluid embolism, fat embolism, idiopathic systemic capillary leak syndrome
- Neurogenic shock – Traumatic brain injury, spinal cord injury (quadriparesis with bradycardia or paraplegia with tachycardia), neuraxial anesthesia
- Anaphylactic shock – IgE-mediated (eg, foods, medications, insect bites or stings), IgE-independent (eg, iron dextran), nonimmumnologic (eg, exercise or heat-induced), idiopathic
- Other – Liver failure, transfusion reactions, vasoplegia (eg, vasodilatory agents, cardiopulmonary bypass), toxic shock syndrome, toxicologic (eg, heavy metals), beriberi
|
| Cardiogenic | Cardiomyopathic | - Myocardial infarction (involving >40% of the left ventricle or with extensive ischemia)
- Severe right ventricle infarction
- Acute exacerbation of severe heart failure from dilated cardiomyopathy
- Stunned myocardium from prolonged ischemia (eg, cardiac arrest, hypotension, cardiopulmonary bypass)
- Advanced septic shock
- Myocarditis
- Myocardial contusion
- Drug-induced (eg, beta blockers)
|
| Arrhythmogenic | - Tachyarrhythmia – Atrial tachycardias (fibrillation, flutter, reentrant tachycardia), ventricular tachycardia and fibrillation
- Bradyarrhythmia – Complete heart block, Mobitz type II second degree heart block
|
| Mechanical | - Severe valvular insufficiency, acute valvular rupture (papillary or chordae tendineae rupture, valvular abscess), critical valvular stenosis, acute or severe ventricular septal wall defect, ruptured ventricular wall aneurysm, atrial myxoma
|
| Hypovolemic | Hemorrhagic | - Trauma, gastrointestinal bleeding (eg, varices, peptic ulcer), intraoperative and postoperative bleeding, retroperitoneal bleeding (eg, ruptured aortic aneurysm), aortic-enteric fistula, hemorrhagic pancreatitis, iatrogenic (eg, inadvertent biopsy of arteriovenous malformation, or left ventricle), tumor or abscess erosion into major vessels, ruptured ectopic pregnancy, postpartum hemorrhage, uterine or vaginal hemorrhage (eg, infection, tumors, lacerations), spontaneous peritoneal hemorrhage from bleeding diathesis
|
| Non-hemorrhagic | - Gastrointestinal losses (eg, diarrhea, vomiting, external drainage); skin losses (eg, heat stroke, burns, dermatologic conditions); renal losses (eg, excessive drug-induced or osmotic diuresis, salt-wasting nephropathies, hypoaldosteronism); third space losses into the extravascular space or body cavities (eg, postoperative and trauma, intestinal obstruction, crush injury, pancreatitis, cirrhosis)
|
| Obstructive | Pulmonary vascular | - Hemodynamically significant pulmonary embolus, severe pulmonary hypertension, severe or acute obstruction of the pulmonic or tricuspid valve, venous air embolus
|
| Mechanical | - Tension pneumothorax or hemothorax (eg, trauma, iatrogenic), pericardial tamponade, constrictive pericarditis, restrictive cardiomyopathy, severe dynamic hyperinflation (eg, elevated intrinsic PEEP), left or right ventricular outflow tract obstruction, abdominal compartment syndrome, aorto-caval compression (eg, positioning, surgical retraction)
|
| Mixed/unknown | | - Endocrine (eg, adrenal insufficiency, thyrotoxicosis, myxedema coma)
- Metabolic (eg, acidosis, hypothermia)
- Other – Polytrauma with more than one shock category, acute shock etiology with pre-existing cardiac disease, late under-resuscitated shock, miscellaneous poisonings
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