A 45-year-old patient undergoes major abdominal surgery. On postoperative day 2, he develops oliguria (urine output 15 mL/hour), BP 90/60 mmHg, HR 115/min, and cold extremities. CVP is low (4 mmHg). What type of shock is this and what is the initial treatment?
- A Cardiogenic shock — dobutamine infusion
- B Septic (distributive) shock — broad-spectrum antibiotics and noradrenaline
- C Hypovolaemic shock — IV fluid resuscitation with crystalloid or blood products ✓
- D Obstructive shock — pericardiocentesis
Correct answer: C. Hypovolaemic shock — IV fluid resuscitation with crystalloid or blood products
Explanation
The clinical picture of hypotension, tachycardia, oliguria, cold peripheries, and LOW CVP in a postoperative patient is consistent with hypovolaemic shock — the low CVP indicates inadequate preload. Initial management is IV fluid resuscitation with crystalloid (e.g., Ringer's lactate) or blood products if blood loss is the aetiology. Cardiogenic shock has high CVP/PCWP; septic shock characteristically has warm peripheries and high cardiac output; obstructive shock from tension pneumothorax or cardiac tamponade has high CVP.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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