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Table 2 Summary of typical findings in different types/causes of shock by SIMPLE approach

From: Make it SIMPLE: enhanced shock management by focused cardiac ultrasound

Type of shock Hypovolemic Cardiogenic Septic Distributive Pulmonary embolism Cardiac Tamponade Aortic Dissection
S Chamber size Small LV Dilated LV Early: small LVESA
Late: normal/dilated
Near normal LVEDA but small LVESA Dilated RV, small/normal LV Diastolic collapse of RA and RV; normal LV Usually normal
I IVC thickness Collapsed Distended <50 % respiratory collapse Early: collapsed
Late: distended
Collapsed Distended and loss of respiratory collapse Distended and loss of respiratory collapse Normal when no cardiac tamponade
IVS movement Normal Reduced Early: normal
Late: reduced
Normal Paradoxical IVS and D-shaped LV Normal Normal
Intimal flap Absent Absent Absent Absent Absent Absent Present
M Myocardial thickening/motion Hyperdynamic Hypokinetic Early: hyperdynamic
Late: hypokinetic
Hyperdynamic or normal McConell’s sign, LV hyperdynamic Diastolic collapse of RA and RV Normal if coronary ostia not involved
Masses in heart Absent Intramural thrombi if AF/AMI Absent Absent Thrombi in RA/RV and IVC Absent Absent
P Pericardial effusion Absent Small amount if inflammatory cause Absent Absent Absent Moderate to large but can be small if acutely collected Present if retrograde dissection and echogenic
Pleural effusion Absent Present Present if pneumonia Absent Usually absent Absent Present if hemothorax
L LV systolic function Hyperdynamic Poor Early: normal or hyperdynamic
Late: impaired
Normal or hyperdynamic Normal or hyperdynamic Normal Normal
E Abdominal aorta in epigastrium Aneurysmal if due to AAA rupture Normal Normal Normal Normal Normal Intimal flap seen
  1. AF atrial fibrillation, AMI acute myocardial infarct, LV left ventricle, LVEDA left ventricular end-diastolic area, LVESA left ventricular end-systolic area, RA right atrium, RV right ventricle