Read the tracing. Name the shock.
Eighteen Swan-Ganz cases with a live waveform console: RA / RV / PA / PCWP, CPO and PAPi, pre- versus post-capillary PH, and the technical lies a catheter can tell — numbers move continuously, not as quiz deltas.
Case library
18 scenarios
- Hypovolemicintro6 min
Dry and tight — the numbers look empty
GI bleed overnight. Cool, thirsty, MAP 58. RA 3, PCWP 6, CO 3.4, SVR high, lactate 3.6. Fill the tank.
Open console - Cardiogenicintro7 min
Cold and wet after the infarct
Anterior STEMI day 1. Cool, wet lungs, UOP 15. MAP 64, RA 14, PCWP 26, CO 2.6, CPO 0.37. Forrester cold-wet.
Open console - Distributiveintro6 min
Warm shock, wide pulse
Pneumonia, fever 39.2, warm extremities. MAP 54, RA 6, PCWP 10, CO 8.4, SVR 460, SvO₂ 78, lactate 4.4.
Open console - Technicalintro5 min
The transducer is on the floor
Impossible numbers: RA −6, PCWP 0, PA 18/2 mean 8, MAP 88, patient chatting. Someone zeroed at the wrong height.
Open console - Obstructiveintermediate7 min
Clear lungs, a dying RV
POD 3, sudden hypoxia and shock. Lungs clear. RA 22, PA 52/32, PCWP 10, CO 2.2, PAPi 0.91, lactate 5.2.
Open console - Obstructiveintermediate7 min
Equalized and empty
CABG day 1. Muffled sounds, pulsus, rising CVP. RA 18, PA 32/18, PCWP 18, CO 2.5. Diastolics are the same number.
Open console - Technicalintermediate6 min
The wedge that isn't
Reported PCWP 34 with PA 36/16 mean 24. CO 4.8, lungs clear, patient looks fine. The number cannot be real.
Open console - PHintermediate7 min
Pre-capillary by the numbers
Unexplained dyspnea. PA 78/32 mean 48, PCWP 11, CO 3.8. PVR is (48−11)/3.8 ≈ 9.7 WU.
Open console - PHintermediate6 min
The left atrium is the problem
HFpEF, obese, AFib. PA 48/22 mean 32, PCWP 24, CO 4.4. PVR = (32−24)/4.4 ≈ 1.8 WU.
Open console - Cardiogenicintermediate7 min
Giant v waves on the wedge
Inferoposterior infarct, new murmur. Mean PCWP 22 but the v wave hits 44. CO 3.2, MAP 68.
Open console - PHintermediate7 min
Resting numbers lie
Unexplained dyspnea. Rest: PA 32/14 mean 20, PCWP 12, CO 5.2. Something is still wrong when she walks.
Open console - High-outputintermediate6 min
High output, still in failure
ESLD, warm, bounding pulse. CO 9.6, PCWP 20, SVR 480, SvO₂ 80. Someone is still hanging fluids ‘for the creatinine.’
Open console - PHintermediate6 min
Five hundred milliliters later
Borderline rest: PCWP 14, mPAP 22, CO 4.8. She cannot exercise. The protocol still has a fluid challenge.
Open console - PHadvanced8 min
Combined pre- and post-capillary
Longstanding HFrEF. PA 82/36 mean 54, PCWP 22, CO 3.4. PVR = (54−22)/3.4 ≈ 9.4 WU — not just a high wedge.
Open console - Cardiogenicadvanced8 min
CPO and PAPi both crashed
INTERMACS 1. MAP 56, CO 2.1, RA 18, PA 42/28, PCWP 26. CPO 0.26 W, PAPi 0.78. Both ventricles are done.
Open console - Mixedadvanced8 min
The sat step-up
Young adult, ‘high-output’ CO 7.8, PA sat 86%, no fever. Lungs quiet. Something is mixing where it should not.
Open console - Cardiogenicadvanced8 min
Inferior infarct, a drowning RA
Inferior STEMI, HR 58, clear lungs. RA 18, PCWP 10, PA 28/16, CO 2.8, PAPi 0.67. The RV is the infarct.
Open console - Mixedadvanced8 min
Cardiogenic plus septic — pick the lever
Ischemic CM plus a new line infection. MAP 58, CO 4.2, SVR 880, PCWP 20, lactate 5.4. Neither profile is pure.
Open console