Patients with which types of shock should not be placed supine?

• A. Hypovolemic and septic
• B. Cardiogenic and obstructive
• C. Anaphylactic and hypovolemic
• D. Neurogenic and septic

Answer: (B)

The key idea is that body position in shock affects how much blood returns to the heart (preload) and how easily the lungs can move air. In cardiogenic shock, the heart is failing to pump effectively. Placing the patient flat increases the amount of blood returning to a struggling heart, which can worsen lung congestion and oxygenation problems. Elevating the head of the bed reduces preload and eases breathing, making a supine position undesirable here.

In obstructive shock, there’s an obstruction to blood flow or filling (such as tamponade, tension pneumothorax, or a massive pulmonary embolism). A flat position can worsen breathing effort and the burden on the heart, while an upright or semi‑upright position can improve chest expansion and reduce the work of breathing, so lying supine is avoided.

By contrast, hypovolemic and septic shock are typically managed with returning fluids and improving circulation, and patients are often kept supine during initial resuscitation to optimize venous return.