Obstructive Shock, from Diagnosis to Treatment

Abstract

Shock is a life threatening pathological condition characterized by inadequate tissue oxygen supply. Four different subgroups of shock have been proposed according to the mechanism causing the shock. Of these, obstructive shock is characterized by reduction in cardiac output due to noncardiac diseases. The most recognized causes include pulmonary embolism, tension pneumothorax, pericardial tamponade and aortic dissection. Since obstructive shock typically cannot be stabilized unless cause for shock is resolved, diagnosis of the underlying disease is eminent. In this review, we therefore focus on diagnosis of obstructive shock and suggest a structured approach in three steps including clinical examination, ultrasound examination using the rapid ultrasound in shock (RUSH) protocol and radiological imaging if needed.

An exceedingly rare cause of neonatal shock and the value of point‐of‐care ultrasound

“…2,11 Therefore, congenital variation of aortic arch and critical CoA with hemodynamic disturbance need to be identified early because its prognosis depends heavily on the correct treatment before severe outcome. 12 Routine physical examinations are limited to seeking the causal factors underlying neonatal shock while POCUS can be deemed an adjunct. 13 POCUS appears to play a more important role among neonates and children, where other monitoring techniques may not be available, but POCUS imaging can be technically easier by reducing the need for radiation and monitoring progress repeatedly in a cost-effective manner.…”

“…However, there are many other causes, such as various cardiomyopathies, incessant arrhythmias, and viral myocarditis, that can result in poor myocardial function and thus have been mistaken as the etiology of neonatal shock 2,11 . Therefore, congenital variation of aortic arch and critical CoA with hemodynamic disturbance need to be identified early because its prognosis depends heavily on the correct treatment before severe outcome 12 …”

An exceedingly rare cause of neonatal shock: persistent fifth aortic arch with critical coarctation

“…However, there are many other causes, such as various cardiomyopathies, incessant arrhythmias, and viral myocarditis, that can result in poor myocardial function and thus have been mistaken as the etiology of neonatal shock. 2,8 Therefore, PFAA with significant hemodynamic disturbance needs to be identified early because its prognosis depends heavily on the correct treatment before severe outcome 9 .…”

Mechanische Kreislaufunterstützung im Schock

“…B. Spannungspneumothorax oder Herzbeuteltamponade) oder eine intravasale Obstruktion (z. B. Lungenembolie) vor [49]. In beiden Fällen ist das Herzminutenvolumen reduziert und der zentralvenöse Druck erhöht [44].…”

“…Die Lungenarterienembolie (LAE) ist durch eine Erhöhung der rechtsventrikulären Nachlast und ein dadurch bedingtes Rechtsherzversagen mit variabel ausgeprägtem respiratorischem Versagen gekennzeichnet [49,77]. Die beste Datenlage existiert für die intravenöse Lysetherapie [53], welche die primäre Therapiestrategie darstellen sollte.…”