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General manifestations of shock:

*Clinical features and symptoms vary according to different types and stages of shock.

The most common clinical features of shock include: hypotension, tachycardia, tachypnea, obtundation or
abnormal mental status, cold, clammy extremities,
mottled skin, oliguria, metabolic acidosis and hyperlactatemia.

Patients with hypovolemic shock can have the mentioned features above as well as evidence of orthostatic
hypotension, pallor, flattened jugular venous pulsation, may
have sequelae of chronic liver disease (in case of variceal bleeding).
Patients with septic shock may have symptoms that reference to the source of infection ex/ ( skin
manifestations of primary infection such as erysipelas, cellulitis, necrotizing soft tissue infections ) and
cutaneous manifestations of infective
Endocarditis.

Patients with anaphylactic shock can have hypotension, flushing, urticaria, tachypnea, hoarseness of voice,
oral and facial edema, hives, wheeze, inspiratory stridor and history of exposure to common allergens such as
medications or food items the patient is allergic to insect stings.

Tension pneumothorax should be suspected in a
patient with undifferentiated shock who has
tachypnea, unilateral pleuritic chest pain, absent or
diminished breath sounds, tracheal deviation to the
normal side, distended neck veins and also has pertinent
risk factors for tension pneumothorax such as recent
trauma, mechanical ventilation, underlying cystic lung
disease.

In a patient with undifferentiated shock, diagnostic
clues to pericardial tamponade as the etiology include
dyspnea, the beck triad (elevated jugular venous
pressure, muffled heart sounds, hypotension), pulses paradoxus and known risk factors such
as trauma, the recent history of pericardial effusion and thoracic procedures.

Cardiogenic Shock should be considered as the etiology if the patient with undifferentiated shock had chest
pain suggestive of cardiac origin, narrow pulse pressure or lung crackles and significant arrhythmias on
telemetry or EKG.

• References:
• Haseer KH, Paul M. Shock. StatPearls [Internet]. 2020 Nov 21
• Angus DC, Van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013 Aug .29;369:840-51
• Standl T, Annecke T, Cascorbi I, Heller AR, Sabashnikov A, Teske W. The nomenclature, definition and distinction of types of shock. Deutsches Ärzteblatt
International. 2018 Nov;115(45):757
• Adams, H. A., et al. "Definition of shock types." Anasthesiologie,
• Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS 36 (2001): S140-3.
• Adams, H. A., Baumann, G., Gänsslen, A., Janssens, U., Knoefel, W., Koch, T., ... & Zander, R. (2001). Definition of shock types. Anasthesiologie,
Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS, 36, S140-3.
• ADAMS, H. A., et al. Definition of shock types. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS, 2001, 36: S140-3.
• Flierl, Ulrike, et al. "Acquired von Willebrand syndrome in cardiogenic shock patients on mechanical circulatory microaxial pump support." PLoS One 12.8
(2017): e0183193.
• Bone, Roger C. "The sepsis syndrome. Definition and general approach to management." Clinics in chest medicine 17.2 (1996): 175-181.
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