Obstructive Shock — Tamponade, Tension Pneumothorax, Massive PE

Meet the patient

A 60-year-old woman, day seven after a hip replacement, collapses on the ward with sudden dyspnoea. She is hypotensive at 75 over 40, tachycardic at 130, SpO2 86 per cent on high-flow oxygen, with distended neck veins. The registrar calls it septic shock and reaches for fluids — but the raised JVP with the low pressure tells a different story.^[1]

A distended JVP with hypotension is obstructive shock until proven otherwise. In hypovolaemic shock the JVP is flat — the blood is on the floor. In obstructive shock it is engorged — the blood cannot get into or through the heart, so it piles up on the venous side. This single bedside observation re-routes the entire differential.^[1]

References18ShowHide

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