Warm, bounding extremities

High cardiac output

Heart is “full” (cardiogenic shock)

Heart is “empty” (hypovolemic shock)

Low cardiac output

JVP, crackles

JVP, orthostasis

Septic shock, liver failure

Antibiotics, aggressive resuscitation

Evaluate for myocardial ischemia

Consider echocardiogram, invasive vascular monitoring

Inotropes, afterload reduction

What does not fit?

Intravenous fluids

No improvement

May convert to

Adrenal crisis, right heart syndrome, pericardial disease

Consider echocardiogram, invasive vascular monitoring