SHOCK

Cold, clammy extremities

Warm, bounding extremities

High cardiac output

Septic shock, liver failure

Heart is "full" (cardiogenic shock)

Heart is "empty" (hypovolemic shock)

Antibiotics, EGDT

Evaluate for myocardial ischemia

Consider echocardiogram, invasive vascular monitoring

Inotropes, afterload reduction

What does not fit?

Adrenal crisis, right heart syndrome, pericardial disease

Consider echocardiogram, invasive vascular monitoring

End

Intravenous fluids

No improvement

May convert to

Low cardiac output

↑ JVP, crackles

↓ JVP, orthostasis