*Cardiogenic shock may be roughly conceptualized as requiring two components:* (1) Systemic hypoperfusion due to low cardiac output (cold).❄️ (2) Filling pressures are elevated due to fluid overload (wet)💧 🥲Giving volume will worsen their pulmonary congestion (making them wetter). 🥲Removing volume will worsen their systemic hypoperfusion (making them colder). Management of cardiogenic shock usually requires interventions to improve cardiac function (e.g., inotropic medications, revascularization, or a mechanical support). Cardiogenic shock patients may look deceptively OK, but they are indeed critically ill. Early recognition facilitates appropriate ICU management. The patient with unrecognized cardiogenic shock will generally fail to respond to non-intensive therapy, running in circles (typically the patient is initially diuresed, then develops worsening renal failure, then is given fluid back, then develops pulmonary edema, then transferred to ICU). https://emcrit.org/ibcc/chf/#bedside_hemodynamic_assessment