Distinguishing categories of shock

Patients: 68 adults with more than 30 minutes of systolic blood pressure <90 mmHg

Examination: performed by medicine house officers.

Outcome: Category of shock classified by a single, blinded, experienced clinician using published consensus guidelines when available.

Results: The combination of estimation of the skin temperature (patient’s hand cooler than the examiner’s hand) and central venous pressure (CVP >7 cm) correctly categorized 52 of 68 cases (accuracy = 76%).

Although not explicitly stated, the categorization seems to be:

Septic shock (37 patients): warm hands; CVP < 8 cm.
Cardiogenic shock (18 patients): cool hands, CVP > 7 cm.
Hypovolemic shock (13 patients): cool hands, CVP < 8 cm.

Comment: The authors used an odd definition of pulse pressure, “same/wider vs. thinner than examiner’s”, which may have prevented this sign from being significant. Other studies have found that a proportional pulse pressure < 25% is predictive of poor cardiac physiology (PMID: 2913385; PMID: 11420761)

This has been added to http://en.citizendium.org/wiki/Shock_(physiology).

Citation

Vazquez R, Gheorghe C, Kaufman D, & Manthous CA (2010). Accuracy of bedside physical examination in distinguishing categories of shock: a pilot study. Journal of hospital medicine : an official publication of the Society of Hospital Medicine, 5 (8), 471-4 PMID: 20945471

Like this:

Be the first to like this post.

This entry was posted on February 11, 2011 at 12:16 am and is filed under Cardiology, Critical care. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

ClinDx