Shock physical examination

Shock Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Shock from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Shock physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Shock physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Shock physical examination
CDC on Shock physical examination
Shock physical examination in the news
Blogs on Shock physical examination
Directions to Hospitals Treating Shock
Risk calculators and risk factors for Shock physical examination

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

Physical Examination

A normal pulse rate is seen in some cases of shock, a phenomenon sometimes confusingly described as relative bradycardia. Paradoxical (absolute) bradycardia is also described. Compensatory mechanisms in the elderly can also be less pronounced and so the typical pattern above may not be seen. Also, young, very fit patients may be able to compensate so well that physiological derangements only manifest when the shock is very severe and sudden decompensation occurs.

Hypovolemic shock

Appearance of the Patient

• Anxiety, restlessness, altered mental state due to decreased cerebral perfusion and subsequent hypoxia.

Vital Signs

• Hypotension due to decrease in circulatory volume.
• A rapid, weak, thready pulse due to decreased blood flow combined with tachycardia.

Other

• • 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.