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{{Shock}}
{{Shock}}
{{CMG}}
{{CMG}}
==Physical Examination==
== Physical Examination ==


A normal pulse rate is seen in some cases of shock, a phenomenon sometimes confusingly described as relative [[bradycardia]].<ref>Demetriades D, Chan LS, Bhasin P, Berne TV, Ramicone E, Huicochea F, et al. Relative bradycardia in patients with traumatic hypotension. The Journal of trauma. 1998;45:534-9. PMID 9751546</ref> 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.
Physical findings depend on the type of shock.


===Hypovolemic shock===
=== Hypovolemic Shock ===


==== Appearance of the Patient ====
==== Appearance of the Patient ====
* Anxiety, restlessness, [[glasgow Coma Scale|altered mental state]] due to decreased cerebral perfusion and subsequent hypoxia.
* Anxiety, restlessness, [[glasgow Coma Scale|altered mental state]] due to decreased cerebral perfusion and subsequent hypoxia.
* [[Fatigue]] due to inadequate oxygenation.
* [[Fatigue]] due to inadequate oxygenation.


====Vital Signs====
==== Vital Signs ====


* Blood Pressure: [[Hypotension]] due to decrease in circulatory volume.
* Blood Pressure: [[Hypotension]] due to decrease in circulatory volume.
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* Temperature:[[Hypothermia]] due to decreased perfusion and evaporation of sweat.
* Temperature:[[Hypothermia]] due to decreased perfusion and evaporation of sweat.


====Skin====
==== Skin ====
 
* Cool, clammy skin due to vasoconstriction and stimulation of vasoconstriction.
* Cool, clammy skin due to vasoconstriction and stimulation of vasoconstriction.
* Mottled skin ([[cutis marmorata]]), especially extremities, due to insufficient perfusion of the skin.
* Mottled skin ([[cutis marmorata]]), especially extremities, due to insufficient perfusion of the skin.


==== Eyes ====
==== Eyes ====
* Distracted look in the eyes or staring into space, often with [[pupils dilated]].
* Distracted look in the eyes or staring into space, often with [[pupils dilated]].


====Throat ====
==== Throat ====
 
* [[Thirst]] and [[dry mouth]], due to fluid depletion.
* [[Thirst]] and [[dry mouth]], due to fluid depletion.


==== Lungs ====
==== Lungs ====
* Rapid and shallow respirations due to sympathetic nervous system stimulation and [[acidosis]].
* Rapid and shallow respirations due to sympathetic nervous system stimulation and [[acidosis]].


=== Cardiogenic Shock ===


===Cardiogenic Shock===
Cardiogenic shock, similar to hypovolaemic shock but in addition the following features:
Cardiogenic shock, similar to hypovolaemic shock but in addition the following features:
====Vital Signs====
 
==== Vital Signs ====
 
* Pulse: Absent pulse due to [[tachyarrhythmia]].
* Pulse: Absent pulse due to [[tachyarrhythmia]].
====Neck====
*Distended [[jugular vein]]s due to increased [[jugular venous pressure]].


===Obstructive Shock===
==== Neck ====
 
* Distended [[jugular vein]]s due to increased [[jugular venous pressure]].
 
=== Obstructive Shock ===
 
Obstructive shock, similar to hypovolaemic shock but in addition:
Obstructive shock, similar to hypovolaemic shock but in addition:


====Vital Signs====
==== Vital Signs ====
 
* Pulse:[[Pulsus paradoxus]] in case of [[tamponade]]
* Pulse:[[Pulsus paradoxus]] in case of [[tamponade]]
====Neck====
 
**Distended [[jugular vein]]s due to increased jugular venous pressure.
==== Neck ====
===Septic Shock===
 
** Distended [[jugular vein]]s due to increased jugular venous pressure.
 
=== Septic Shock ===
 
Septic shock, similar to hypovolaemic shock except in the first stages:
Septic shock, similar to hypovolaemic shock except in the first stages:
====Vital Signs====
 
*Temperature: [[Pyrexia]] or [[hyperthermia]], due to overwhelming [[bacterial infection]].
==== Vital Signs ====
====Skin====
 
**Vasodilation  due to sepsis.
* Temperature: [[Pyrexia]] or [[hyperthermia]], due to overwhelming [[bacterial infection]].
====Heart====
 
==== Skin ====
 
** Vasodilation  due to sepsis.
 
==== Heart ====
 
* Increased [[cardiac output]] due to [[sepsis]].
* Increased [[cardiac output]] due to [[sepsis]].


===Neurogenic Shock===
=== Neurogenic Shock ===
 
Neurogenic shock, similar to hypovolaemic shock except in the skin's characteristics.
Neurogenic shock, similar to hypovolaemic shock except in the skin's characteristics.
====Skin====
 
==== Skin ====
 
* In neurogenic shock, the skin is warm and dry.
* In neurogenic shock, the skin is warm and dry.


===Anaphylactic Shock===
=== Anaphylactic Shock ===
====Vital Signs====
 
*Weak and rapid pulse.
==== Vital Signs ====
====Skin====
 
* Weak and rapid pulse.
 
==== Skin ====
 
* Skin eruptions and large welts.
* Skin eruptions and large welts.
====Head====
 
*Localised [[edema]], especially around the face.
==== Head ====
====Throat====
 
* Localised [[edema]], especially around the face.
 
==== Throat ====
 
* Cough due to [[bronchospasm|narrowing of airways]] and [[edema|swelling of the throat]].
* Cough due to [[bronchospasm|narrowing of airways]] and [[edema|swelling of the throat]].
====Lungs====
 
==== Lungs ====
 
* [[Breathlessness]]
* [[Breathlessness]]


Revision as of 18:38, 5 March 2013

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

Physical Examination

Physical findings depend on the type of shock.

Hypovolemic Shock

Appearance of the Patient

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

Vital Signs

  • Blood Pressure: Hypotension due to decrease in circulatory volume.
  • Pulse: A rapid, weak, thready pulse due to decreased blood flow combined with tachycardia.
  • Temperature:Hypothermia due to decreased perfusion and evaporation of sweat.

Skin

  • Cool, clammy skin due to vasoconstriction and stimulation of vasoconstriction.
  • Mottled skin (cutis marmorata), especially extremities, due to insufficient perfusion of the skin.

Eyes

  • Distracted look in the eyes or staring into space, often with pupils dilated.

Throat

Lungs

  • Rapid and shallow respirations due to sympathetic nervous system stimulation and acidosis.

Cardiogenic Shock

Cardiogenic shock, similar to hypovolaemic shock but in addition the following features:

Vital Signs

Neck

Obstructive Shock

Obstructive shock, similar to hypovolaemic shock but in addition:

Vital Signs

Neck

    • Distended jugular veins due to increased jugular venous pressure.

Septic Shock

Septic shock, similar to hypovolaemic shock except in the first stages:

Vital Signs

Skin

    • Vasodilation due to sepsis.

Heart

Neurogenic Shock

Neurogenic shock, similar to hypovolaemic shock except in the skin's characteristics.

Skin

  • In neurogenic shock, the skin is warm and dry.

Anaphylactic Shock

Vital Signs

  • Weak and rapid pulse.

Skin

  • Skin eruptions and large welts.

Head

  • Localised edema, especially around the face.

Throat

Lungs

References

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