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Review
. 2022 Jun 29;23(7):248.
doi: 10.31083/j.rcm2307248. eCollection 2022 Jul.

Obstructive Shock, from Diagnosis to Treatment

Viviane Zotzmann  1 , Felix A Rottmann  1   2 , Katharina Müller-Pelzer  3 , Christoph Bode  1   4 , Tobias Wengenmayer  1 , Dawid L Staudacher  1
Affiliations
Review

Obstructive Shock, from Diagnosis to Treatment

Viviane Zotzmann et al. Rev Cardiovasc Med. .

Abstract

Shock is a life threatening pathological condition characterized by inadequate tissue oxygen supply. Four different subgroups of shock have been proposed according to the mechanism causing the shock. Of these, obstructive shock is characterized by reduction in cardiac output due to noncardiac diseases. The most recognized causes include pulmonary embolism, tension pneumothorax, pericardial tamponade and aortic dissection. Since obstructive shock typically cannot be stabilized unless cause for shock is resolved, diagnosis of the underlying disease is eminent. In this review, we therefore focus on diagnosis of obstructive shock and suggest a structured approach in three steps including clinical examination, ultrasound examination using the rapid ultrasound in shock (RUSH) protocol and radiological imaging if needed.

Keywords: circulatory shock; obstructive shock; review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1.
Fig. 1.
Transversal (A,B) and coronal (C) reconstructions of a computed tomography (CT) angiography shwoeing a rare cause for obstructive shock. (A) Tumor mass (TU) infiltrating the right ventricular wall and left ventricular ouitflow tract. (B) The tumor (TU) mass compresses the right artrium (RA) and right ventricle (RV). The tumor has no direct contact to the left ventricle (LV). (C) Demonstrates tumor grophs along the right heart in coronal reconstruction. Adapted from [12].
Fig. 2.
Fig. 2.
Ultrasound in obstructive shock. (A) TTE shows a wormously configured thrombus in the right atrium with clearly dilated right ventricles and completely emptied left ventricle. RA, right atrium; RV, right ventricle; LA, left atrium. (B) Lung sonography (LUS) shows A-lines and a missing lung sliding (white arrow), while lung on the right side is normal. (C) TTE shows a large pericardial effusion (white arrows) with swinging heart. RA, right atrium; RV, right ventricle; LA, left atrium; LV, left ventricle.
Fig. 3.
Fig. 3.
Diagnostic algorithm in obstructive shock.
See this image and copyright information in PMC

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