Shock physical examination

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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

• Thirst and dry mouth, due to fluid depletion.

Lungs

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

Cardiogenic Shock

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

Vital Signs

• Pulse: Absent pulse due to tachyarrhythmia.

Neck

• Distended jugular veins due to increased jugular venous pressure.

Obstructive Shock

Obstructive shock, similar to hypovolemic shock but in addition:

Vital Signs

• Pulse:Pulsus paradoxus in case of tamponade

Neck

• Distended jugular veins due to increased jugular venous pressure.

Septic Shock

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

Vital Signs

• Temperature: Pyrexia or hyperthermia, due to overwhelming bacterial infection.

Skin

• Vasodilation due to sepsis.

Heart

• Increased cardiac output due to sepsis.

Neurogenic Shock

Neurogenic shock, similar to hypovolemic 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

• Cough due to narrowing of airways and swelling of the throat.

Lungs

• Breathlessness