Shock Backgrounds

Background

In the emergency department (ED), a quick and easy-to-use hemodynamic monitor, such as the
EC Monitors, are vital in differentiating shock patients. Shock is a serious, life-threatening medica
l condition that occurs when there is not enough blood entering the body’s tissue to meet cellu
lar metabolic needs. In most patients shock is identified by extremely low blood pressure (hypot
ension) and inadequate organ perfusion, caused either by low cardiac output (CO) or low syste
mic vascular resistance (SVR).

Save Time - Diagnosis & Treament

Current ED protocols for differential diagnosis of shock takes a significant amount of time. For e
xample, to differentially diagnose septic shock it can take from 20 to 45 minutes to perform a t
horough investigation. Using the EC Monitors in shock can potentially cut down the time necess
ary for diagnosis, for treatment, and ultimately improve patient outcomes.1 The EC Monitors pro
vide an easy 3 minute test which can obtain sufficient data for differential diagnoses of the spe
cific type of shock. Additionally, a real-time continuous measurement of hemodynamic parameter
s allows for physicians to carefully observe the responses to medication and titrate accordingly.

Differential Diagnosis of Shock

Cardiogenic Shock

In these patients, the reason for the shock is pump failure (the heart). The typical characteristics
of cardiogenic shock are low stroke volume (SV), low contractility (ICON), high heart rate (HR), l
ow cardiac output (CO), high systolic time ratio (STR), and low left cardiac work (LCW).

Treatment: Immediate inotropes to correct the low contractility of the heart.

Example: Hemodynamic assessment of a patient with cardiogenic shock measured by an EC mo

nitor

SV: Low

ICON: Low
HR: High

CO: Low

STR: High

LCW: Low

TFI: Normal to Low

SVR: Normal to High

Hypovolemic Shock

In this case of shock, the patient is losing too much blood or fluid. The typical characteristics of
hypovolemic shock are low SV, high HR, low TFC, and high SVR.

Treatment: Increase fluids or blood transfusion.

Example: Hemodynamic assessment of a patient with hypovolemic shock measured by an EC mo

nitor

SV: Low

ICON: Normal

HR: High

CO: Normal to Low Normal

STR: Normal to Low

LCW: Normal

TFI: Low

SVR: High

Septic Shock (early stage)

This type of shock is caused by a massive infection by septicemia of the blood and blood vesse
ls. When the blood vessel walls become infected, they lose their tone which causes severe vaso
dilatation. In response to vasodilation, CO increases drastically. The typical characteristics of septi
c shock are a high CO and low SVR.
Treatment: Massive antibiotics and fluids.

Example: Hemodynamic assessment of a patient with septic shock measured by an EC monitor

SV: Normal

ICON: Normal

HR: High

CO: High

STR: Normal

LCW: Normal

TFI: Normal

SVR: Low

Anaphylactic Shock

Anaphylactic shock is caused by massive vasodilation usually occurring because of sensitivities to

medication and/or any other material. It is characterized by very low SVR and normal to high S
V, CO and HR to compensate for the low SVR.

Treatment: Vasoconstrictors (and fluids if needed) to correct the low after-load.

Example: Hemodynamic assessment of a patient with anaphylactic shock measured by an EC mo

nitor

SV: Normal to high

ICON: Normal

HR: High

CO: Normal to high

STR: Normal

LCW: Normal

TFI: Normal to low

SVR: Very Low

Dyspnea

Dyspnea, shortness of breath or difficulty breathing, is a symptom caused by either a cardiovasc

ular or a non-cardiovascular (typically pulmonary) problem. Determining dyspnea, especially in pa
tients with a history of both cardiac and pulmonary disorders, can be difficult. Although, non -inv
asive hemodynamic measurements of Cardiac Index (CI) and Systolic Time Ratio (STR) have been
shown to be a significant aid in differentiating between cardiac and non-cardiac occurrences of
dyspnea.2,3

In less than 3 minutes the EC Monitors can determine CI and STR non-invasively to aid in the
differential diagnosis of dyspnea. Analyzing CI and STR, has shown to result in a 13% greater se
nsitivity and specificity in differentiating the cause of dyspnea (being cardiac or pulmonary) com
pared to using standard criteria and a 39% improvement in chosen treatment plans.4

1 Nassef, Y. (2011, June 26). Differentiating Shock.

2 Springfield C, et al. Utility of Impedance Cardiography to Determine Cardiac vs Noncardiac Ca

use of Dyspnea in the Emergency Department. Congest Heart Fail. 2004; 10(suppl2):14-16

3 Lo, HY, et al. Utility of impedance cardiography for dyspneic patients in the ED. Am. J. Emerg
ency Medicine (2007) 25,437-441

4 Peacock WF et al. Impact of Impedance Cardiography on Diagnosis and Therapy of Emergent

Dyspnea: The ED-IMPACT Trial. Acad Emerg Med. 2006; 13(4):365-371