Shock physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Physical Examination

• Hypovolemic shock
  • Anxiety, restlessness, altered mental state due to decreased cerebral perfusion and subsequent hypoxia.
  • Hypotension due to decrease in circulatory volume.
  • A rapid, weak, thready pulse due to decreased blood flow combined with tachycardia.
  • Cool, clammy skin due to vasoconstriction and stimulation of vasoconstriction.
  • Rapid and shallow respirations due to sympathetic nervous system stimulation and acidosis.
  • Hypothermia due to decreased perfusion and evaporation of sweat.
  • Thirst and dry mouth, due to fluid depletion.
  • Fatigue due to inadequate oxygenation.
  • Cold and mottled skin (cutis marmorata), especially extremities, due to insufficient perfusion of the skin.
  • Distracted look in the eyes or staring into space, often with pupils dilated.
• Cardiogenic shock, similar to hypovolaemic shock but in addition:
  • Distended jugular veins due to increased jugular venous pressure.
  • Absent pulse due to tachyarrhythmia.
• Obstructive shock, similar to hypovolaemic shock but in addition:
  • Distended jugular veins due to increased jugular venous pressure.
  • Pulsus paradoxus in case of tamponade
• Septic shock, similar to hypovolaemic shock except in the first stages:
  • Pyrexia and fever, or hyperthermia, due to overwhelming bacterial infection.
  • Vasodilation and increased cardiac output due to sepsis.
• Neurogenic shock, similar to hypovolaemic shock except in the skin's characteristics. In neurogenic shock, the skin is warm and dry.
• Anaphylactic shock
  • Skin eruptions and large welts.
  • Localised edema, especially around the face.
  • Weak and rapid pulse.
  • Breathlessness and cough due to narrowing of airways and swelling of the throat.