Annexure 3.

Criteria for establishing Diagnosis 3 (combination of data from clinical evaluation and PoCUS)—Column A + Column B

Type of shock	Column A (clinical evaluation alone)	Column B (PoCUS alone)
Cardiogenic shock	Any or a combination of the below associated with chest pain	Hypokinetic LV or hypokinetic LV and RV with IVC >2 cm dilated and noncollapsing on PoCUS
	Syncope, pain abdomen, generalized weakness, seizures, altered sensorium, vomiting, loose stools
	ECG findings with ST elevation, ST depression, T inversion, LBBB
	Raised JVP, pedal edema, anasarca, ascites, tender hepatomegaly, hepatojugular reflex
	History of progressive breathlessness, paroxysmal nocturnal dyspnea, orthopnea, dyspnea on exertion
	Past history of cardiac, pulmonary, or renal disease, diabetes, hypertension
Hypovolemic shock	Any or a combination of the below associated with vomiting or loose stools or both without fever and normal temperature at ED evaluation	Hyperkinetic LV with >50% collapsing IVC of diameter <2 cm
	Pain abdomen, generalized weakness	OR
	History of hematemesis, bleeding per rectum, hemoptysis	Only >50% collapsing IVC of diameter <2 cm OR
	UPT positive with sudden onset of abdominal pain	Abdominal PoCUS suggestive of free fluid with >50% collapsing IVC of diameter <2 cm with or without hyperkinetic LV
Obstructive shock	Breathlessness or chest pain with history suggestive of DVT	Hypokinetic RV with multiple A lines with or without consolidation and noncollapsing IVC of diameter >2 cm with or without DVT on PoCUS
		OR
		Pericardial effusion with or without hypokinetic RV and noncollapsing IVC of diameter >2 cm on PoCUS
Distributive shock	Any or combination of the below with fever or temperature >100.4°F at ED evaluation abdomen, generalized weakness, cough, seizures, vomiting, loose stools	Consolidation associated with or without air bronchogram with or without IVC collapsing on PoCUS
	Altered sensorium, breathlessness, pain
	OR
	Only fever or temperature > 100.4°F at ED evaluation
	Evident focus of sepsis on clinical examination
	History suggestive of anaphylaxis, hepatic insufficiency, pancreatic insufficiency, CVA, nontraumatic SAH, spinal cord pathology
Cardiogenic with distributive shock	Clinical history suggestive of cardiogenic shock with evident focus of sepsis, SIRS on clinical examination	Features suggestive of cardiogenic shock with evident focus of sepsis on PoCUS
Hypovolemic with distributive shock	Clinical history suggestive of hypovolemia with evident focus of sepsis, SIRS on clinical examination	Features suggestive of hypovolemia with evident focus of sepsis on PoCUS