 Let's continue on and discuss various types of shock. We will discuss hypovolemic shock, cardiogenic shock, obstructive shock, and distributive shock. With each various types of shock, we want to cover the causes of each shock and how they present and what various physiologic effects are occurring under each type of shock, and then finally we'll cover treatments. So for hypovolemic shock, hypovolemic shock is caused by hemorrhage, dehydration, and burns. Obviously, we're decreasing the volume of our blood, so this is going to be either due to complete loss of total blood products or a third spacing that we often see with burns. The skin presentation of hypovolemic shock is cold and clammy. Physiologically, we see a large decrease in the preload on the heart. As you think this through, we're completely decreasing the total blood volume, so therefore there's going to be less blood coming back to the heart to go through that circulation. On that same note, we also will decrease our cardiac output. When there's less coming back to pump, there's less that's going to be pumped out. Finally, our afterload will increase. This is a compensatory mechanism of the body to adjust for that decrease in the cardiac output. Treatment for hypovolemic shock is IV fluids. We need to increase the total body volume of fluid, so we give IV fluids to try and help mitigate that loss of blood. In cardiogenic shock, we can see that during acute myocardial infarctions and heart failure, valvular dysfunctions, and arrhythmias. Once again, in a similar fashion as hypovolemic shock, cardiogenic shock has cold and clammy skin. The preload can go either up or down, depending upon what stage of cardiogenic shock that we're in. Our cardiac output, however, will decrease, and typically this is a strong decrease or a high decrease in the cardiac output. And in the same way as hypovolemic shock, we do see an increase in the afterload as a compensatory mechanism of the body. Treat this with positive ionotropes and diuresis. Diuresis to decrease that preload if we're struggling with an increase in the preload there. Obstructive shock is caused by cardiac tamponade, pulmonary embolism, and tension pneumothorax. Once again, the skin presentation here is cold and clammy. Obstructive shock presents in the same manner as cardiogenic shock where our preload can go either up or down. Our cardiac output is greatly decreased, and then our afterload is going to be increased. The treatment, however, between cardiogenic shock and obstructive shock is different. The obstructive shock treatment is to just relieve the obstruction. So if you have a tamponade or an embolism or a pneumothorax, we fix that problem, and that will help relieve our obstructive shock. The final type of shock we will discuss is distributive shock. This is caused by sepsis, anaphylaxis, and central nervous system injuries. This is the only skin presentation that is different from the other three, and that our skin will be warm and dry. Preload in distributive shock is going to be decreased, whereas the cardiac output will typically be increased. There is an opportunity for the cardiac output to be decreased, especially in CNS injuries, but for the most part, a distributive shock will increase our cardiac output. In both cases, we will see a decrease in our afterload. Treatment for distributive shock is going to include IV fluids, pressers to increase our afterload, and then epinephrine that we can use in anaphylaxis.