What is the grade of shock in a patient with hypotension, tachycardia, and mild tachypnea?

Shock Classification in Post-RTA Patient

The patient with blood pressure 80/60, HR 110, RR 20 is in stage C (class cardiogenic shock) according to the SCAI classification system, which corresponds to third stage shock.

Shock Classification Systems

• The American College of Cardiology/American Heart Association classifies cardiogenic shock into stages, with stage C defined as a patient who manifests hypoperfusion requiring intervention (inotrope, pressor or mechanical support) beyond volume resuscitation to restore perfusion, typically presenting with relative hypotension 1
• This patient's vital signs (BP 80/60, HR 110, RR 20) indicate hypotension with compensatory tachycardia and mild tachypnea, consistent with class C shock 1
• The European Society of Cardiology defines cardiogenic shock as hypotension (SBP < 90 mmHg) despite adequate filling status with signs of hypoperfusion 1

Clinical Parameters Supporting Third Stage (Class C) Shock

• Blood pressure of 80/60 mmHg is below the threshold of 90 mmHg systolic that defines hypotension in shock 1, 2
• Heart rate of 110 bpm represents compensatory tachycardia, a mechanism to maintain cardiac output in the face of decreased stroke volume 2, 3
• Respiratory rate of 20 breaths/min indicates mild tachypnea, suggesting the body's attempt to compensate for metabolic acidosis that commonly occurs in shock 2, 3

Ruling Out Other Shock Stages

• This is not first stage (Class A) shock, as the patient already has hypotension and tachycardia rather than just being at risk 1
• This is not second stage (Class B) shock, as the patient has hypotension with a systolic BP of 80 mmHg, not just relative hypotension or tachycardia without hypoperfusion 1
• This is not fourth stage (Class D or E) shock, as there is no indication of deterioration despite interventions (Class D) or cardiac arrest requiring CPR/ECMO (Class E) 1

Management Implications of Stage C Shock

• Patients in class C shock require immediate intervention beyond just fluid resuscitation 1
• Pharmacologic therapy aims to improve organ perfusion by increasing cardiac output and blood pressure 1
• After fluid challenge, pharmacologic management consists of an inotropic agent and a vasopressor as needed 1
• Continuous monitoring of organ perfusion and hemodynamics is essential 1, 2

Important Clinical Considerations

• Immediate comprehensive assessment including ECG and echocardiography is required for all patients with suspected cardiogenic shock 1, 2
• Invasive monitoring with an arterial line should be considered for accurate blood pressure measurement 1, 3
• In post-RTA patients, consider both cardiogenic shock from cardiac contusion/injury and hypovolemic shock from occult bleeding 4, 5
• Early recognition and appropriate classification of shock is crucial for timely intervention and improved outcomes 6, 7