Page 387 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

CHAPTER 33: Shock 257

TABLE 33-4 Causes of and Contributors to Shock TABLE 33-4 Causes of and Contributors to Shock (Continued)
Decreased pump function of the heart—cardiogenic shock Massive pleural effusion
Left ventricular failure Positive-pressure ventilation
Systolic dysfunction—decreased contractility High intra-abdominal pressure
Myocardial infarction Ascites
Ischemia and global hypoxemia Massive obesity
Cardiomyopathy After extensive intra-abdominal surgery
Depressant drugs: β-blockers, calcium channel blockers, antiarrhythmics Intravascular hypovolemia (reduced mean systemic pressure)
Myocardial contusion Hemorrhage
Respiratory acidosis Gastrointestinal
Metabolic derangements: acidosis, hypophosphatemia, hypocalcemia Trauma
Diastolic dysfunction—increased myocardial diastolic stiffness Aortic dissection and other internal sources
Ischemia Renal losses
Ventricular hypertrophy Diuretics
Restrictive cardiomyopathy Osmotic diuresis
Consequence of prolonged hypovolemic or septic shock Diabetes (insipidus, mellitus)
Ventricular interdependence Gastrointestinal losses
External compression (see cardiac tamponade below) Vomiting
Diarrhea
Greatly increased afterload
Gastric suctioning
Aortic stenosis
Loss via surgical stomas
Hypertrophic cardiomyopathy
Dynamic outflow tract obstruction Redistribution to extravascular space
Burns
Coarctation of the aorta
Trauma
Malignant hypertension
Valve and structural abnormality Postsurgical
Mitral stenosis, endocarditis, mitral aortic regurgitation Sepsis
Decreased venous tone (reduced mean systemic pressure)
Obstruction owing to atrial myxoma or thrombus
Papillary muscle dysfunction or rupture Drugs
Ruptured septum or free wall Sedatives
Narcotics
Arrhythmias
Diuretics
Right ventricular failure Anaphylactic shock
Decreased contractility Neurogenic shock
Right ventricular infarction, ischemia, hypoxia, acidosis
Increased resistance to venous return
Greatly increased afterload Tumor compression or invasion
Pulmonary embolism Venous thrombosis with obstruction
Pulmonary vascular disease
PEEP
Hypoxic pulmonary vasoconstriction, PEEP, high alveolar pressure
Pregnancy
Acidosis High cardiac output hypotension
ARDS, pulmonary fibrosis, sleep disordered breathing, chronic obstructive Septic shock
pulmonary disease
Sterile endotoxemia with hepatic failure
Valve and structural abnormality Arteriovenous shunts
Obstruction due to atrial myxoma, thrombus, endocarditis
Dialysis
Arrhythmias
Paget disease
Decreased venous return with normal pumping function—hypovolemic shock
Other causes of shock with unique etiologies
Cardiac tamponade (increased right atrial pressure—central hypovolemia) Thyroid storm
Pericardial fluid collection Myxedema coma
Blood
Adrenal insufficiency
Renal failure Hemoglobin and mitochondrial poisons
Pericarditis with effusion Cyanide
Constrictive pericarditis
Carbon monoxide
High intrathoracic pressure
Iron intoxication
Tension pneumothorax
ARDS, acute respiratory distress syndrome; PEEP, positive end-expiratory pressure.

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