shocks

 Q; Patients with severe acute myocardial infarction (MI) can have? (select one)

A) cardiogenic shock 

B) obstructive shock 

C) hemorrhagic shock 

D) all of the above

Answer: D

The objective of the above question is to highlight the fact that most shock situations are rarely a pure single entity. They may start as a single form of shock such as distributive, hypovolemic, hemorrhagic, or mechanical but soon culminate into a combined form of shock. 

One of the examples is severe acute MI which may start as a pure cardiogenic shock but with a ruptured left ventricular wall, may become an obstructive shock because of cardiac tamponade - or hemorrhagic shock with blood loss. Similarly, septic shock may start as a pure distributive shock bur after massive volume resuscitation, may culminate into mechanical shock due to abdominal compartment syndrome, and/or cardiogenic shock due to acute right heart failure.

#hemodynamics

References:

1. Standl T, Annecke T, Cascorbi I, Heller AR, Sabashnikov A, Teske W. The Nomenclature, Definition and Distinction of Types of Shock. Dtsch Arztebl Int. 2018;115(45):757-768. doi:10.3238/arztebl.2018.0757

2. Kislitsina ON, Rich JD, Wilcox JE, et al. Shock - Classification and Pathophysiological Principles of Therapeutics. Curr Cardiol Rev. 2019;15(2):102-113. doi:10.2174/1573403X15666181212125024