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Shock - Coggle Diagram

- - - - Problem: Pump
    - - Hypotension
      - Reduced CI (< 2.2 L/min/m2)
      - Elevated filling pressures (PAOP > 15 – 18 mmHg)
      - SVR normal to high
  - - - Problem: Fluid
    - - Loss of intravascular volume or hemoglobin impairs DO2
      - Physiologic Response to Hemorrhage
        
        Class IV (Supply << Demand)
        
        Membranes leak and depolarize; cell death
        
        Class III (Supply < Demand)
        
        Critical DO2 decrease; anaerobic metabolism
        
        Class II (Supply = Demand)
        
        Recruitment of capillaries; Eventual activation of humoral response (hrs)
        (days; antidiuretic hormone, renin, aldosterone)
        
        Class 1 (Supply = Demand)
        
        Restribution of bloow flow (min)
  - - - Problem: Pipe
    - - CVP: Decreased
        PCWP: Decreased
        CO: Decreased
        SVR: Decreased
    - - CVP: Increased
        PCWP: Increased
        CO: Increased
        SVR: Decreased
    - - Hypoperfusion due to decreased SVR
      - Failure of vascular smooth muscle constriction
        
        Septic shock: hyperinflammatory response leads to vasodilation
        
        Neurogenic shock: decrease in sympathetic outflow from the CNS
        
        Immune-mediated shock: IgE-mediated mast cell or basophil degranulation
  - - - Problem: Pipe, pump
    - - CVP: Increased
        PCWP: Increased
        CO: Decreased
        SVR: Increased
    - - CVP: Increased
        PCWP: Decreased or no change
        CO: Decreased
        SVR: Increased
    - - Extra-cardiac obstruction to flow (decreased CO)
        
        Impaired diastolic filling
        
        Inhibition of venous return --> ↓RV preload
        Example: cardiac tamponade, tension pneumothorax
        
        Impaired systolic contraction
        
        Example: massive PE, acute pulmonary hypertension (PH)