Circulatory shock

How would you code this? R57.8 other shock or R57.9 shock, unspecified?

Comments

  • I guess technically it's "other" but just curious if there were indicators for a more specific code?

    Jeff

  • I summarized this a while back from my days working in Critical Care. I think R57.8 is the correct choice.

    Classifications of Circulatory Shock 

    A.    Hypodynamic shock - low cardiac index and a high-resistance vasoconstricted state. Increased oxygen extraction and lactic acidosis usually parallel the decrease in cardiac output. The development of organ dysfunction is directly related to inadequate global blood flow.

    Types:  

     

    1. Hypovolemic Shock (do to dehydration and massive capillary leak) R57.1                                           

    2. Hemorrhagic Shock 2/2 surgery T81.19 2/2 trauma T79.4

    3. Cardiogenic Shock-(MI, Cardiomyopathies, and severe valvular lesions) R57.0

    4. Obstructive Shock (pericardial tamponade, acute PE, and tension pneumothorax) R57.8

     

    B.    Hyperdynamic shock  - high cardiac output and a low-resistance vasodilated state.

     Types:

     5. Vasodilatory Shock (Filling pressures can be increased or normal depending on volume status and myocardial competence) R 57.8

    6. Septic Shock R65.21

    7. Anaphylactic Shock T78.2

    8. Spinal Shock R57.8

    9. Vasoplegic or Distributive shock (Adrenal insufficiency where the underlying hemodynamic defect is maldistribution of blood flow and/or blood volume such that effective nutrient blood flow is compromised.) R 57.8

     Considerable overlap may exist between these different syndromes. Early in septic and anaphylactic shock, prior to fluid infusion, a significant hypovolemic component usually exists. Hypovolemia may be present in a small group of patients presenting with shock due to acute myocardial infarction. In the presence of severe sepsis-related myocardial depression, patients with septic shock can develop a hypodynamic profile. Similarly, patients in cardiogenic shock after myocardial infarction and cardiac surgery may demonstrate significant vasodilation due to the activation of mediator cascades while on cardiopulmonary bypass.

     Reference:

    JEAN-LOUIS VINCENT, MD, PhD,

    EDWARD ABRAHAM, MD

    FREDERICK A. MOORE, MD, FACS, FCCM

    PATRICK M. KOCHANEK, MD, FCCM

    MITCHELL P. FINK, MD

    2012 TEXTBOOK OF CRITICAL CARE


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