6.2 Signs and symptoms of shock

Shock is a life-threatening condition where the body can't deliver enough oxygen to vital organs. It's crucial to recognize the signs early. From pale, cool skin to rapid breathing and weak pulse, these symptoms indicate the body's struggle to maintain blood flow.

Shock affects multiple systems, causing altered mental status, fatigue, and reduced urine output. Understanding these signs helps first responders quickly identify and treat shock, potentially saving lives. Prompt recognition and action are key to preventing organ damage and improving outcomes.

Skin and Vital Signs

Abnormal skin appearance and temperature

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• Pale skin indicates reduced blood flow to the skin surface due to blood being diverted to vital organs (brain, heart, lungs)
• Cool skin suggests a decrease in body temperature as a result of impaired thermoregulation and reduced peripheral circulation
• Clammy skin refers to a cold, sweaty feeling caused by the body's attempt to maintain blood pressure through increased sympathetic nervous system activity

Changes in pulse and breathing

• Rapid, weak pulse is a compensatory mechanism to maintain adequate cardiac output and blood pressure in the face of decreased blood volume or cardiac function
• Rapid, shallow breathing (tachypnea) occurs as the body tries to compensate for the decreased oxygen delivery to tissues by increasing the rate of respiration
• Hypotension, or low blood pressure, is a key sign of shock as the cardiovascular system struggles to maintain adequate perfusion to vital organs

Neurological Symptoms

Altered mental status and cognition

• Restlessness or confusion may occur due to reduced cerebral blood flow and oxygenation, leading to impaired brain function
• Altered mental status can range from mild disorientation to complete unresponsiveness (coma) depending on the severity and duration of shock
• Patients may exhibit difficulty focusing, answering questions, or following commands as a result of cerebral hypoperfusion

Fatigue and weakness

• Weakness or fatigue is common in shock due to inadequate oxygen and nutrient delivery to muscles and other tissues
• Patients may feel exhausted or have difficulty moving their limbs as a result of cellular energy depletion and lactic acid accumulation

Gastrointestinal and Urinary Symptoms

Reduced urine output

• Decreased urine output (oliguria) occurs as the kidneys attempt to conserve fluid and maintain circulating blood volume in response to hypoperfusion
• Urine output of less than 0.5 mL/kg/hour in adults or less than 1 mL/kg/hour in children is a sign of inadequate renal perfusion and potential acute kidney injury

Thirst and nausea

• Thirst is a common symptom of shock as the body senses a decrease in circulating blood volume and attempts to stimulate fluid intake
• Nausea may occur due to reduced blood flow to the gastrointestinal tract, leading to hypoxia and irritation of the gut lining
• Vomiting can further exacerbate fluid and electrolyte imbalances in shock patients