Rapid evaluation of shock is essential given its life-threatening nature. Diagnosis requires a thorough history, physical exam, and additional tests. One must also consider the possibility of multiple types of shock being present. For example, a trauma patient may be hypovolemic from blood loss. This patient could also have tension pneumothorax due to trauma to the chest. Vital signs in<unk>  may show hypotension, tachycardia, and/or hypoxia. A physical exam include be thorough, including jugular vein exam, cardiac and lung exams, and assessing skin tone and temperature. Response to fluids may aid in diagnosis. Labs including a metabolic panel can assess electrolytes and kidney and liver function. Lactic acid rises due to poor tissue perfusion. This may even be an initial sign of shock and rise before blood pressure decreases. Lactic acid should lower with appropriate treatment of shock. EKG should also be performed. Tachycardia is often present, but other specific findings may be present based on the underlying cause. At the bedside, point-of-care echocardiography should be used. This is non-invasive and can help diagnose the four types of shock. Echocardiography can look for ventricular dysfunction, effusions, or valve dysfunction. Measurement of the vena cava during the breathing cycle can help assess volume status. A point-of-care echocardiogram can also assess for causes of<unk> . The vena cava would be dilated due to the obstruction. In pulmonary embolism, the right ventricle will be dilated. Other findings include paradoxical septal motion or clots in the right heart or pulmonary artery. Echocardiography can assess for pericardial effusion. In tamponade, collapse of the right atrium and ventricle would be seen due to pressure in the pericardial sac. A chest X-ray can rapidly identify a pneumothorax, seen as absence of lung markings. Ultrasound can show the lack of lung sliding. However, imaging should not delay treatment. CT angiography is the standard of diagnosis of pulmonary embolism. Clots appear in the vasculature as filling defects.
Obstructive shock
Distributive shock
Hypovolemic shock
Cryptic shock
Neurogenic shock
Vasodilatory shock
Septic shock
Cardiogenic shock