18.9C: Signs and Symptoms of Shock

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The clinical manifestation of shock varies depending on the type of shock and the individual, but there are some general symptoms.

Learning Objectives

Differentiate among the types of shock and the signs and symptoms associated with each

Key Points

The general signs for all types of shock are low blood pressure, decreased urine output, and confusion. However, these may not always be present.
Hypovolemic shock is characterized by loss of effective circulating blood volume, which leads to rapid pulse, cool skin, shallow breathing, hypothermia, thirst, and cold mottled skin.
Cardiogenic shock is characterized by distended jugular veins, weak or absent pulse, and arrhythmia.
Distributive shock includes septic shock, characterized by fever or anaphylaxis, and neurogenic shock, characterized by a reduced heart rate and vasodilation of superficial vessels warming the skin.

The presentation of shock varies. Some people presenting only minimal symptoms, such as confusion and weakness. Typical symptoms of shock include elevated but weak heart rate, low blood pressure, and poor organ function, typically observed as low urine output, confusion or loss of consciousness.

While a fast heart rate is common, those on beta blockers and those who are athletic may have a normal or slow heart rate. This also occurs in 30% of cases of shock caused by abdominal bleeding. Specific subtypes of shock may have additional symptoms.

Hypovolemic shock results from the direct loss of effective circulating blood volume. This leads to a rapid, weak pulse due to decreased blood flow combined with tachycardia, stimulation of vasoconstriction, and cool, clammy skin. It also presents with acidosis as well as rapid, shallow breathing due to sympathetic nervous system stimulation. Hypothermia due to decreased perfusion and evaporation of sweat, and thirst and dry mouth due to fluid depletion, may also be present.

Anaphalactic Hives: Hives and flushing on the back of a person with anaphylaxis.

The symptoms of cardiogenic shock are similar to those of hypovolemic shock. Additional symptoms may include arrhythmia of the heart beat and visibly distended jugular veins.

Distributive shock includes septic, anaphylactic, and neurogenic causes. With septic shock, fever may occur and the skin may be warm and sweaty. With anaphylaxis, hives may present on the skin, and there may localized edema, especially around the face, and weak and rapid pulse. Breathlessness and cough due to narrowed airways and swelling of the throat may also occur. The symptoms of neurogenic shock are distinct from those of classical shock, as the heart rate slows and and superficial vessels vasodilate and warm the skin. These symptoms are caused by neural damage and resultant loss of muscle control.