A 45-year-old post-operative patient develops oliguria (urine output 15 mL/h), BP 85/50 mmHg, CVP 2 cmH2O, cold peripheries, and clear lung fields. Cardiac output monitoring shows cardiac output 2.1 L/min and systemic vascular resistance (SVR) 2,800 dyne·s·cm⁻⁵. This haemodynamic profile is MOST consistent with:

• A Hypovolaemic shock ✓
• B Distributive (septic) shock
• C Cardiogenic shock
• D Obstructive shock (pulmonary embolism)

Explanation

The haemodynamic profile of hypovolaemic shock: low cardiac output, high SVR (compensatory vasoconstriction), low CVP, cold extremities, and oliguria. Distributive shock (sepsis) shows HIGH cardiac output (hyperdynamic) and LOW SVR (vasodilation), with warm extremities. Cardiogenic shock shows low CO and high SVR (similar to hypovolaemic) but high filling pressures (elevated CVP and PCWP) with pulmonary oedema. Obstructive shock (PE) shows elevated CVP, high SVR, low CO, with right heart strain signs. The combination of low CO, high SVR, and low CVP with cold extremities is classic for hypovolaemic shock.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.