Chart — Critical Care
Shock Type Hemodynamic Comparison
Hemodynamic parameter patterns side-by-side for all shock types — cardiac output, SVR, filling pressures, clinical signs, and first-line treatment.
Educational use only. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
| Shock Type | CO/CI | SVR | CVP | PCWP | HR | SvO₂ |
|---|---|---|---|---|---|---|
| Hypovolemic | ↓↓ | ↑↑ | ↓ | ↓ | ↑↑ | ↓ |
| Distributive — Septic (early) | ↑ (hyperdynamic) | ↓↓ | ↓ | ↓ | ↑↑ | ↑ (early) / ↓ (late) |
| Distributive — Anaphylactic | ↑ / ↓ | ↓↓ | ↓ | ↓ | ↑↑ | Variable |
| Distributive — Neurogenic | ↓ / ↔ | ↓↓ | ↓ | ↓ | ↓ (bradycardia — no sympathetic tone) | Variable |
| Cardiogenic | ↓↓ | ↑↑ | ↑ | ↑↑ | ↑ / variable | ↓↓ |
| Obstructive — Massive PE | ↓↓ | ↑↑ | ↑↑ | ↓ / ↔ | ↑↑ | ↓ |
| Obstructive — Cardiac Tamponade | ↓↓ | ↑↑ | ↑↑ | ↑ (equalization of pressures) | ↑↑ | ↓ |
↑↑ = significantly elevated | ↑ = elevated | ↔ = near normal | ↓ = reduced | ↓↓ = significantly reduced | CO = Cardiac Output | SVR = Systemic Vascular Resistance | PCWP = Pulmonary Capillary Wedge Pressure
Clinical Signs and First-Line Treatment
| Shock Type | Skin / Clinical Signs | First-Line Treatment |
|---|---|---|
| Hypovolemic | Cool, pale, diaphoretic | IV fluid resuscitation; identify and control blood/fluid loss |
| Distributive — Septic (early) | Warm, flushed (early); later cool | Norepinephrine + fluids + antibiotics (Surviving Sepsis Bundle) |
| Distributive — Anaphylactic | Flushed, urticaria, angioedema | Epinephrine IM 0.3–0.5 mg; IV fluids; antihistamines; corticosteroids |
| Distributive — Neurogenic | Warm, dry (paradoxical — loss of sympathetic vasoconstriction) | Phenylephrine or norepinephrine; IV fluids; spinal stabilization; atropine if bradycardia severe |
| Cardiogenic | Cool, pale, diaphoretic; peripheral vasoconstriction | Dobutamine (inotrope); ± vasopressor; diuresis if congested; consider IABP, Impella, VA ECMO |
| Obstructive — Massive PE | Pale, diaphoretic; possible cyanosis (right heart failure) | Anticoagulation (immediate); thrombolytics if massive; catheter-directed or surgical embolectomy |
| Obstructive — Cardiac Tamponade | Cool, diaphoretic; JVD; muffled heart sounds | Emergent pericardiocentesis; IV fluids to maintain preload; avoid positive pressure ventilation if possible |
Pattern Recognition Pearls
- ›Low CO + Low SVR = Distributive (open vessels; pump okay; need to constrict).
- ›Low CO + High SVR = Cardiogenic (failing pump; high resistance is compensatory).
- ›Low CO + Low CVP/PCWP = Hypovolemic (empty tank; fill with volume).
- ›High CVP + Low PCWP = Obstructive PE (right heart obstructed; left heart underfilled).
- ›High CVP + High PCWP (equalization) = Tamponade (pericardial pressure compressing all chambers equally).
- ›Warm skin + bradycardia + low BP = Neurogenic (lost sympathetic tone — unique among shock states).
- ›SvO₂ high in early septic shock: high CO + maldistribution — cells cannot extract O₂ despite adequate delivery.
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with Society of Critical Care Medicine (SCCM) · Surviving Sepsis Campaign · American Association of Critical-Care Nurses (AACN). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →