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The values given are approximate and certain special considerations should be borne in mind. For instance, patients on [[:Category:Betablockers|&beta;-blockers]] may not be able to mount a significant [[tachycardia]]. 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.
The values given are approximate and certain special considerations should be borne in mind. For instance, patients on [[:Category:Betablockers|&beta;-blockers]] may not be able to mount a significant [[tachycardia]]. 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.
==Signs and symptoms==
*'''Hypovolemic shock'''
**Anxiety, restlessness, [[Glasgow Coma Scale|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 vein]]s due to increased [[jugular venous pressure]].
**Absent pulse due to tachy[[arrhythmia]].
*'''Obstructive shock''', similar to hypovolaemic shock but in addition:
**Distended [[jugular vein]]s 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 [[bronchospasm|narrowing of airways]] and [[edema|swelling of the throat]].


==Related Chapters==
==Related Chapters==

Revision as of 20:18, 4 February 2013

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

Clinical Recognition

End-organ hypoperfusion affects virtually all body systems and can manifest in several clinically detectable ways:

The values given are approximate and certain special considerations should be borne in mind. For instance, patients on β-blockers may not be able to mount a significant tachycardia. A normal pulse rate is seen in some cases of shock, a phenomenon sometimes confusingly described as relative bradycardia.[1] 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.

Related Chapters

References

  1. 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

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