Shocked? CHOD Is the Answer

Trying to work out what is causing your patient’s shocked state is not only of diagnostic importance but will also guide you management, but first:

What is shock?

Shock is a clinical state in which tissue hypoxia results from mismatched oxygen supply and demand

How is CHOD going to help me ?

CHOD is a simple mnemonic covering the causes of shock.

[peekaboo_link name=”cardiogenic”]Cardiogenic[/peekaboo_link] [peekaboo_content name=”cardiogenic”]
  • ‘Pump Failure’
    • Causes include:
      • Ischaemia
      • Arrhythmia – ‘too fast’ or ‘too slow’
      • Cardiomyopathy
      • Myocarditis
      • Value or papillary muscle rupture
    • Treatment options include:
      • Correct reversible cause e.g. cardioversion, reperfusion
      • Supportive Care
[/peekaboo_content] [peekaboo_link name=”hypovolaemic”]Hypovolaemic[/peekaboo_link] [peekaboo_content name=”hypovolaemic”]
  • Commonest cause of shock
    • Losses can occur via a number of mechanisms including:
      • Blood Loss e.g. trauma, ectopic pregnancy
      • GI Loss e.g. diarrhoea
      • Dermal Loss e.g. burns
      • Renal Loss e.g. diuresis
    • Treatment includes:
      • Replace volume
      • Stop losses
[/peekaboo_content] [peekaboo_link name=”obstructive”]Obstructive[/peekaboo_link][peekaboo_content name=”obstructive”]
  • Obstruction to cardiac filling or cardiac output
    • Causes include:
      • Tension Pneumothorax
      • Pulmonary Embolism
      • Pericardial Tamponade
    • Treatment includes:
      • Remove the obstruction !
[/peekaboo_content] [peekaboo_link name=”distributive”]Distributive[/peekaboo_link] [peekaboo_content name=”distributive”]
  • Loss of peripheral vascular tone
    •  Causes include:
      • Sepsis
      • Neurogenic (Spinal Injury)
      • Anaphylaxis
      • Drugs & Toxins
    • Treatment includes:
      • Dependent on underlying cause
      • Supportive care

To read a more about individual causes click on the links above.


  • Bersten AD, Soni N. Oh’s Intensive Care Maual. Butterworth Heinemann Elsevier. Sixth Edition. 2009. Google books

One thought on “Shocked? CHOD Is the Answer

  1. Hey John
    If you want to be super-inclusive, you could add a second D, ie CHODD, which includes ‘Dissociative’ shock. Causes include severe anaemia, and Cyanide poisoning, where there is either inadequate release of oxygen, or inadequate utilisation of oxygen at the cellular level.

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