determine if hypovolemia is improved A decrease in the IVC respiratory variation may indicate that the patient may not respond to further fluid resuscitation An IVC/Ao ratio of to 1.4 is indicative of euvolemia, and >1.4 is indicative of hypervolemia It is important to note that positive pressure ventilation may distend the IVC and limit the evaluation of fluid status using the IVC/Ao ratio Cardiogenic Shock Cardiogenic shock is often difficult to distinguish from other shock states, as a prolonged history of worsening symptoms is less common in children as compared to adult heart failure Historical information should be obtained regarding chest pain, syncope, known cardiac abnormalities, and cardiac medications On physical examination, one should assess the following: Neck: Jugular venous distention Cardiac: Murmur, gallop, perfusion abnormalities including delayed capillary refill, diminished or bounding pulses Respiratory: Respiratory distress, rales to suggest pulmonary edema Abdomen: Hepatomegaly Extremities: Peripheral edema, delayed capillary refill POCUS findings: Distended IVC, right and/or left ventricular or biventricular dysfunction, possible ventricular dilation, pulmonary edema may be seen on lung ultrasound Obstructive Shock On physical examination, one should assess the following: Neck: Jugular venous distention Cardiac: Murmur, gallop Respiratory: Unilateral decreased breath sounds suspicious for tension pneumothorax Abdomen: Hepatomegaly Extremities/skin: Poor perfusion, cyanosis in unrepaired congenital heart disease including differential perfusion, and cyanosis between the upper and lower extremities to indicate interrupted aortic arch or critical aortic coarctation Beck triad in cardiac tamponade: Distended neck veins, hypotension, diminished heart sounds POCUS findings: Distended IVC, possible right ventricular dilation and systolic dysfunction in pulmonary embolism or tension pneumothorax, possible pericardial effusion in cardiac tamponade