An empty IVC and hyperkinetic heart does not equal volume depletion. This combination of echocardiographic findings may result from either vasodilatory shock (as illustrated above) or hypovolemic shock. If encountered in the setting of hypovolemia (for example, a patient with GI hemorrhage), then volume repletion is clearly indicated.

However, if encountered in the setting of vasodilatory shock, then the best treatment may be vasoconstriction with an agent such as norepinephrine.

The treatment should correct the underlying problem. Simply because a shocked patient is volume responsive does not mean that volume is the best treatment.

Bedside ultrasonography must be combined with an understanding of physiology.

One potential pitfall of bedside ultrasonography is that it may be so visually impressive that it seduces us into forgetting physiology.

The empty IVC virtually begs us to administer volume. However, we must remain steadfast to the principles of cardiovascular hemodynamics as we carefully consider the entire picture in determining the best possible treatment.

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