1d • General discussion
🚨 Shock States Made Simple: Understanding the 4 Patterns That Save Lives
Shock is one of the most critical conditions we encounter in healthcare.
It looks chaotic, dramatic, and fast-moving, but underneath the urgency lies a simple principle:
👉 Shock = inadequate tissue perfusion.
👉 Cells are starving.
👉 The body is fighting to survive.
Recognising which type of shock you’re facing allows you to intervene with precision instead of guessing.
Let’s break down the four classic shock types into clear, memorable patterns.
1️⃣ Hypovolemic Shock “Not Enough Volume”
Cause:
Loss of circulating volume → reduced preload → reduced cardiac output.
Why it happens:
Hemorrhage
Severe dehydration
Burns
GI losses
What it looks like:
Tachycardia
Low blood pressure
Cool, clammy skin
Narrow pulse pressure
Low JVP / flat neck veins
Fast, shallow breathing
Treatment focus:
🩸 Replace the volume → fluids, blood, stop the loss.
Key pattern:
Empty tank = empty arteries = cold + fast + low BP.
2️⃣ Cardiogenic Shock “Pump Failure”
Cause:
The heart cannot pump effectively → low cardiac output despite normal volume.
Why it happens:
MI
Heart failure
Arrhythmias
Cardiomyopathy
Mechanical failure (papillary rupture, valve issues)
What it looks like:
Hypotension
Tachycardia (or bradyarrhythmias)
Cool, mottled skin
Crackles in lungs
High JVP / pulmonary congestion
Weak pulses
Treatment focus:
❤️ Support the pump → inotropes, revascularisation, rhythm correction.
Key pattern:
Tank is full, pump is failing.
3️⃣ Obstructive Shock “Blocked Flow”
Cause:
The heart wants to pump, but something physically obstructs forward flow.
Why it happens:
Cardiac tamponade
Tension pneumothorax
Massive PE
Severe pulmonary hypertension
What it looks like:
Sudden hypotension
Tachycardia
Distended neck veins
Clear lungs (except PE-related)
Pulsus paradoxus in tamponade
Tracheal deviation (tension pneumo)
Treatment focus:
🛠️ Remove the obstruction → decompress, drain, dissolve, or relieve.
Key pattern:
Normal pump + normal tank, but the pipes are squeezed shut.
4️⃣ Distributive Shock “Massive Vasodilation”
Cause:
Blood vessels lose tone → blood flow becomes misdistributed → relative hypovolemia.
Main types:
Septic shock
Anaphylactic shock
Neurogenic shock
What it looks like:
Sepsis:
Fever or hypothermia
Warm, flushed skin early
Bounding pulses → then late vasoconstriction
Hypotension despite fluids
Anaphylaxis:
Hives, airway swelling
Hypotension
Wheeze / stridor
GI symptoms
Neurogenic:
Bradycardia
Warm, dry skin
Low blood pressure
Occurs after spinal cord injury
Treatment focus:
🔥 Vasoconstrict & support perfusion → vasopressors, fluids, treat the cause (antibiotics, adrenaline, etc.).
Key pattern:
Pipes are too wide → blood can’t reach the right places.
🔍 The Simple Pattern That Never Fails
Think of shock like a plumbing problem:
Is there fluid in the system?
→ Hypovolemic
Is the pump working?
→ Cardiogenic
Is the flow blocked?
→ Obstructive
Are the pipes too wide?
→ Distributive
Once you identify the pattern, the treatment becomes obvious.
📌 Why Knowing Shock Patterns Matters
Because shock is time-sensitive, and misidentifying the type can lead to the wrong treatment and rapid deterioration.
The goal is simple:
Recognise early
Classify accurately
Treat the underlying cause fast
Shock isn’t just a number on a record, it’s a pattern.
Learn the pattern, and you save lives.
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🚨 Shock States Made Simple: Understanding the 4 Patterns That Save Lives
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