Chart — Critical Care
Shock Type Comparison Chart
A side-by-side comparison of the four major shock categories — hypovolemic, cardiogenic, distributive, and obstructive — with distinguishing hemodynamic profiles, clinical features, and treatment priorities.
Educational use only. Shock management requires immediate provider involvement and institution-specific protocols. This chart supports learning and clinical differentiation, not independent treatment decisions. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Shock Type Comparison
| Type | Cause | Hemodynamics | Clinical Findings | Treatment Priorities |
|---|---|---|---|---|
| Hypovolemic | Blood/fluid loss: hemorrhage, burns, dehydration, third-spacing | CO ↓CVP ↓SVR ↑MAP ↓ | TachycardiaCool, pale, clammy skinFlat neck veinsThirst, oliguria | Control bleeding/fluid sourceIV fluid/blood productsVasopressors only after volume |
| Cardiogenic | Pump failure: massive MI, HF, dysrhythmia, myocarditis | CO ↓↓CVP ↑SVR ↑MAP ↓ | JVD, pulmonary cracklesCool, clammy skinS3 gallopPulmonary edema | Treat underlying causeNorepinephrine (MAP)Dobutamine (inotrope)Avoid excess fluids |
| Distributive | Sepsis, anaphylaxis, neurogenic, adrenal crisis | CO ↑ (early) / ↓ (late)CVP ↓SVR ↓↓MAP ↓ | Warm, flushed skin (early)Bounding pulses (early)Fever (sepsis)Urticaria (anaphylaxis) | Fluids + vasopressors (sepsis)Epinephrine (anaphylaxis)Antibiotics + source control |
| Obstructive | Tension pneumothorax, tamponade, massive PE | CO ↓↓CVP ↑SVR ↑MAP ↓ | JVD, muffled heart soundsTracheal deviation (tension PTX)Absent breath soundsPulsus paradoxus (tamponade) | Relieve obstruction firstNeedle decompression (tension)Pericardiocentesis (tamponade)Anticoagulation/thrombolytics (PE) |
Key Differentiating Features
JVD and Lung Sounds
Raised JVD + pulmonary crackles = cardiogenic (congested). Raised JVD without crackles + absent breath sounds or muffled hearts sounds = obstructive. Flat neck veins + clear lungs = hypovolemic. Clear lungs + warm skin = distributive.
SVR Direction
Hypovolemic, cardiogenic, and obstructive all have elevated SVR (compensatory vasoconstriction — cold, clammy). Distributive has low SVR (vasodilation — warm, flushed). This skin temperature distinction is clinically powerful in early assessment.
Fluid Response
Hypovolemic shock responds well to fluids. Cardiogenic and obstructive shock do not benefit from aggressive fluids and may worsen. Distributive shock requires fluids to restore preload but also vasopressors to address the SVR deficit.
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with AHA / ACCCM Critical Care Guidelines. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →