Read the tracing. Name the shock.
Twenty Swan-Ganz cases with a live waveform console: RA / RV / PA / PCWP, CPO and PAPi, pre- versus post-capillary PH, the technical lies a catheter can tell, and crises such as venous air embolism — numbers move continuously, not as quiz deltas.
Case library
20 scenarios
- Hypovolemicintro6 min
Case 01 — Overnight GI bleed
GI bleed overnight. Cool, thirsty, MAP 58. RA 3, PCWP 6, CO 3.4, SVR high, lactate 3.6. The intern wants dobutamine.
Open console - Cardiogenicintro7 min
Case 02 — Day 1 after STEMI
Anterior STEMI day 1. Cool, wet lungs, UOP 15. MAP 64, RA 14, PCWP 26, CO 2.6, CPO 0.37. A fluid bag is in hand “for the kidneys.”
Open console - Distributiveintro6 min
Case 03 — Febrile shock
Pneumonia, fever 39.2, warm extremities. MAP 54, RA 6, PCWP 10, CO 8.4, SVR 460, SvO₂ 78, lactate 4.4. An inotrope is already ordered.
Open console - Technicalintro5 min
Case 16 — Numbers don't match the patient
RA −6, PCWP 0, PA 18/2 mean 8. MAP 88 and the patient is sitting up discussing lunch.
Open console - Obstructiveintermediate7 min
Case 04 — Sudden shock, clear lungs
POD 3, sudden hypoxia and shock after standing. Lungs clear. RA 22, PA 52/32, PCWP 10, CO 2.2, PAPi 0.91, lactate 5.2. Fluids are running.
Open console - Obstructiveintermediate7 min
Case 05 — CABG day 1
CABG day 1. Quiet heart sounds, narrowing pulse pressure, rising CVP. RA 18, PA 32/18, PCWP 18, CO 2.5.
Open console - Technicalintermediate6 min
Case 06 — Unexpected wedge
Overnight note: wedge 34, diurese. PA 36/16 mean 24, CO 4.8. Lungs clear, patient sitting up talking.
Open console - PHintermediate7 min
Case 07 — Unexplained dyspnea
Unexplained dyspnea. PA 78/32 mean 48, PCWP 11, CO 3.8. A nitroprusside trial is already written.
Open console - PHintermediate6 min
Case 08 — HFpEF workup
Known HFpEF, obese, AFib. Wet to the mid-scapulae. PA 48/22 mean 32, PCWP 24, CO 4.4.
Open console - Cardiogenicintermediate7 min
Case 10 — New murmur after infarct
Inferoposterior infarct, new murmur, flash edema. Digital wedge 22; the tracing shows large systolic waves to 44. CO 3.2, MAP 68.
Open console - PHintermediate7 min
Case 12 — Dyspnea on exertion
Unexplained dyspnea on one flight of stairs. Rest: PA 32/14 mean 20, PCWP 12, CO 5.2. The bike is in the room.
Open console - High-outputintermediate6 min
Case 13 — Cirrhosis, still congested
ESLD, warm, bounding pulse. CO 9.6, PCWP 20, SVR 480, SvO₂ 80. Fluids are still hanging “for the creatinine.”
Open console - PHintermediate6 min
Case 15 — Borderline rest study
Unexplained dyspnea. She cannot exercise. Rest PCWP 14, mPAP 22, CO 4.8. The protocol still lists a 500 mL challenge.
Open console - PHadvanced8 min
Case 09 — Longstanding HFrEF
Longstanding HFrEF, “out of proportion” PA pressures. PA 82/36 mean 54, PCWP 22, CO 3.4.
Open console - Cardiogenicadvanced8 min
Case 11 — INTERMACS 1
INTERMACS 1, second inotrope, pressor climbing. MAP 56, CO 2.1, RA 18, PA 42/28, PCWP 26. CPO 0.26 W, PAPi 0.78.
Open console - Mixedadvanced8 min
Case 14 — Young adult, high output
Young adult, loud S2. Thermodilution CO 7.8, PA sat 86%, no fever. Lungs quiet.
Open console - Cardiogenicadvanced8 min
Case 17 — Inferior STEMI
Inferior STEMI, HR 58, clear lungs, JVP up. RA 18, PCWP 10, PA 28/16, CO 2.8, PAPi 0.67. Nitroglycerin is on the STEMI bundle.
Open console - Mixedadvanced8 min
Case 18 — Two processes at once
Ischemic cardiomyopathy, EF 20%, new fever off a PICC. MAP 58, CO 4.2, SVR 880, PCWP 20, lactate 5.4.
Open console - Obstructiveadvanced8 min
Case 19 — After the line pull
IJ pulled with the patient sitting. He gasped as the hub opened. EtCO₂ 14, MAP 52. RA 20, PA 40/18, PCWP 8, CO 2.0. The hub is still open.
Open console - Obstructiveadvanced8 min
Case 20 — During CRRT
CVVH bag change. The return limb hissed, then shock. EtCO₂ 12, SpO₂ 76, RA 19, PA 38/16, PCWP 7, CO 1.9. The limb is still open to the room.
Open console