Evaluation and management of shock in patients with COVID-19

Article Figures & Data

TABLE 1

Key parameters in the evaluation of shock

Physical examination

Capillary refill

Mental status

Extremity temperature

Urine output

Focused echocardiography

LV systolic function

RV size and function

LVOT VTI

Pericardial effusion

Mitral, aortic, and tricuspid valve assessment

Regional wall motion abnormality

Laboratory studies

Mixed venous oxygen saturation

Central venous oxygen saturation

Lactate

LV = left ventricle; LVOT VTI = left ventricular outflow tract velocity time integral; RV = right ventricle

TABLE 2

Common shock etiologies and differentiation strategies

Type of shock	Etiologies	Extremities	Cardiac output	Mixed venous O₂	LV systolic function	RV size/function
Distributive	Sepsis Cytokine storm^{^a} Medication-related vasoplegia Anaphylaxis Neurogenic	Warm (sometimes cold)	Normal or high	Normal or high	Normal or high	Normal
Cardiogenic	Pre-existing heart disease Acute myocardial ischemia Cardiomyopathy Acute myocarditis	Cold	Low	Low	Low	Normal or dilated/reduced function
	Acute valvular disease	Cold	Low	Low	Normal or hyperdynamic	Variable
	Right ventricle failure^{^a}	Cold	Low	Low	Normal or hyperdynamic	Dilated/reduced function
Obstructive	Pulmonary embolism^{^a}	Cold	Low	Low	Normal or hyperdynamic	Dilated/reduced function
Obstructive	Dynamic hyperinflation (auto-PEEP) Pericardial tamponade Abdominal compartment syndrome Pneumothorax^{^a}	Cold	Low	Low	Normal or hyperdynamic	Normal
Hypovolemic	Volume depletion Hemorrhage	Cold	Low	Low	Normal or hyperdynamic	Normal