Shock classification (pediatrics)

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Shock classification often describes its own cause of shock condition, i.e. bleeding, trauma, sepsis etc. This terminology connected with the underlying cause is, of course, acceptable. However, using the selected criteria, it is possible to determine the shock states of the 5 main categories and to distinguish:

According to the Nelson Textbook of Pediatrics 2007, septic shock is excluded from the distribution shock group as a separate type of shock. This is due to its mixed nature of pathogenesis, where in addition to a distribution disorder we find hypovolemia ("third spacing") and cardiogenic depression (the effect of endotoxin, cytokines, etc.). Even outside of the above division, this only proves that in the clinical picture we often distinguish 'mixed shock' . It is a combination of two, sometimes three basic types. One type usually predominates in this mixed image. A typical example is traumatic shock, which is most often a combination of hypovolemic and distributional shock, but depending on the nature of the injury, it can also be a cardiogenic or obstructive shock.

Hemodynamic determinants of shock states (Fuhrman, Zimmerman – Pediatric Critical Care, 1998)
TYPE OF SHOCK Cardiac index SVRI MAP Pulmonary Capillary Wedge Pressure CVP
Hypovolemic ↔ or ↓ ↓↓↓ ↓↓↓
Cardiogenic – systolic dysfunction ↓↓ ↑↑↑ ↔ or ↓ ↑↑ ↑↑
Cardiogenic – diastolic dysfunction ↑↑ ↑↑
Obstructive ↔ or ↓ ↑↑ ↑↑
Distributional ↑↑ ↓↓↓ ↔ or ↓ ↔ or ↓ ↔ or ↓
Sepsis – early phase ↑↑↑ ↓↓↓ ↔ or ↓
Sepsis – late phase ↓↓ ↑↑ ↓↓ ↔ or ↓

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  • HAVRÁNEK, Jiří: Šok. (upraveno)

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