Acute Care 41: Shock Acronym—SHRIMPCAN
One way of defining the cause of shock and the appropriate treatment is:
1. Cardiac rate problem
• heart contracts too slowly to meet the metabolic demands
• heart beats too rapidly to allow effective heart filling during
diastole
• results in a significant decrease in cardiac output.
2. Pump problem
• primary heart abnormalities resulting in inadequate cardiac
output
• due to a decrease in preload
• vascular obstruction resulting in inadequate venous return to the
heart
• decrease in cardiac output
3. Volume problem
• vascular volume loss
either from hemorrhage or systemic fluid loss
• results in vasodilation or third space fluid loss such that
hypotension occurs
Consider the mnemonic SHRIMPCAN to help develop a broad differential if the cause is still unknown to you.
| S | Sepsis—gram-negative infection or other overwhelming infection |
| H | Hypovolemia
resulting from hemorrhage, dehydration, vomiting,
peritonitis, pancreatitis, leaking aneurysm, ectopic pregnancy |
| R | Respiratory
compromise resulting in hypoxia, tension pneumothorax,
massive pulmonary embolus |
| I | Ingestion of a toxic substance, drug overdose |
| M | Metabolic
causes including diabetic ketoacidosis, hyperosmolar coma,
myxedema, adrenal insufficiency, electrolyte abnormalities |
| P | Psychiatric causes such as water intoxication |
| C | Cardiogenic
shock, acute myocardial infarction, cardiomyopathy, cardiac
tamponade, dysrhythmias, severe cardiac failure, valvular heart disease, atrial myxomas |
| A | Anaphylactic shock |
| N | Neurogenic causes such as spinal shock, herniation syndromes, intracranial bleed |