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Remove the clot from a massive PE (pulmonary embolism). Use needle decompression and a chest tube to treat a tension pneumothorax. Opt for pericardiocentesis to treat a cardiac tamponade. Treat the underlying cause of constrictive pericarditis as needed. Treat severe aortic stenosis if this is the underlying cause of shock.
If a pulmonary embolism is confirmed as the cause of obstructive shock, it is key to have this treated as soon as possible. Sometimes a "thrombolytic" (clot-busting) drug can be considered to treat a large pulmonary embolism. However, in cases of severe shock, surgery or a catheter removal is usually the fastest and most effective way to remove the PE and thus relieve the obstruction. If a tension pneumothorax is responsible for the onset of obstructive shock, insert a needle in the affected area for decompression. This procedure is called a "needle decompression." Following insertion of the needle, treatment of the pneumothorax, and stabilization of shock symptoms, you will get a chest tube for ongoing management to prevent any recurrence of the tension pneumothorax. This procedure also involves using a needle. However, in this case, the needle is used to remove fluid from the pericardial sac. Removal of the fluid (normally blood) from the pericardial sac in turn relieves the pressure on the heart, and removes the obstruction that was the underlying cause of shock. Of course, it is key to determine what caused the cardiac tamponade in order to have complete and lasting resolution of shock. The needle pericardiocentesis can be done repeatedly, if necessary, to alleviate pressure on the heart until the underlying cause is resolved. In other cases, a surgical procedure known as a pericardial window is done to relieve the accumulation of the fluid. If constrictive pericarditis (or a related condition) is responsible for obstructive shock, it is key to determine what is causing compression and tightening of the heart sac (called the "pericardium"). If this is unable to be resolved and treated promptly, the heart sac (pericardium) may need to be cut open surgically to relieve pressure on the heart, and to resolve the symptoms of obstructive shock. An intra-aortic balloon pump (IABP) can be used to help open the aortic valve. This, in turn, will allow blood to exit the heart and to more effectively supply the body's vital organs. The IABP intervention has been shown to relieve symptoms of obstructive shock when aortic stenosis is diagnosed as the underlying etiology (cause). The aortic valve should be evaluated, and replaced if it meets the criteria.