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Recognizing Shock: Key Signs and Symptoms

Shock is life-threatening circulatory failure with inadequate tissue perfusion. Early recognition saves lives.

Cardinal Signs (Hypovolemic/Distributive/Cardiogenic/Obstructive)

  • Cool, Pale, Clammy Skin: Peripheral vasoconstriction (compensatory).
  • Tachycardia: Compensatory; may be absent in β-blocked, athletic, or neurogenic shock.
  • Tachypnea: Compensatory respiratory alkalosis; later metabolic acidosis → Kussmaul breathing.
  • Hypotension: Late sign (compensation maintains BP until ~30% volume loss).
  • Altered Mental Status: Confusion, agitation, lethargy, coma (cerebral hypoperfusion).
  • Oliguria: <0.5 mL/kg/hr (renal hypoperfusion).
  • Weak/Thready Pulses: Decreased stroke volume.
  • Capillary Refill >2 sec: Peripheral shutdown.

Type-Specific Clues

  • Hypovolemic: Flat neck veins, history of loss (hemorrhage, GI, burns).
  • Distributive (Septic/Anaphylactic/Neurogenic): Warm/flushed skin (early septic), bounding pulses (early), bronchospasm/hives (anaphylaxis), bradycardia/warm paralyzed limbs (neurogenic).
  • Cardiogenic: JVD, pulmonary edema, S3, cool extremities.
  • Obstructive: Tension pneumothorax (tracheal deviation, absent breath sounds), tamponade (muffled heart sounds, pulsus paradoxus), massive PE.

Immediate Action

  1. Call 911 / Activate Code.
  2. ABCs: Airway, Breathing, Circulation.
  3. IV Access ×2 Large Bore: Crystalloid bolus (30 mL/kg) — except cardiogenic (cautious).
  4. Oxygen: Target SpO₂ ≥94%.
  5. Monitor: Continuous ECG, SpO₂, BP, urine output, lactate.
  6. Source Control: Stop bleeding, antibiotics (sepsis), decompression (tension PTX), pericardiocentesis (tamponade).
  7. Vasopressors: Norepinephrine (first-line) if fluid-refractory.

Shock is a medical emergency. Early aggressive resuscitation improves survival.

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