Septic Vs Cardiogenic Shock

Two patients can walk onto your unit with the same numbers on the monitor and need opposite treatment. Both are hypotensive, tachycardic, confused and passing very little urine. The difference is why the circulation is failing, and that decides whether the next litre of fluid saves the patient or drowns them. Consider two patients. - Patient A is a 73-year-old admitted with pneumonia. She develops fever, confusion, HR 126/min, BP 82/46 mmHg, warm extremities and a lactate of 4.1 mmol/L. - Patient B is a 69-year-old admitted with an acute myocardial infarction. He develops HR 118/min, BP 78/44 mmHg, cool clammy extremities, bilateral crackles, jugular venous distension and a lactate of 4.6 mmol/L. Both patients need immediate emergency escalation and a rapid assessment of airway, breathing, circulation and perfusion. Do not wait to name the shock before you act. Patient A has findings concerning for sepsis-associated distributive shock. Patient B has findings concerning for cardiogenic shock. The distinction matters because treatment differs. IV crystalloid resuscitation is commonly indicated for sepsis-associated hypoperfusion, whereas indiscriminate fluid administration may worsen pulmonary oedema in...