Key Feature 5a: In a patient with signs and symptoms of shock: Recognize the shock.
Skill: Clinical Reasoning, Selectivity Phase: Hypothesis generation, Diagnosis Key Feature 5b: In a patient with signs and symptoms of shock: Define the severity and type (neurogenic, hypovolemic, septic). Skill: Clinical Reasoning, Selectivity Phase: Physical, Diagnosis You would expect a patient with shock to appear unwell and activate that nerve in your stethoscope that tells you a patient seems unwell. Indeed, this may very well be the case, but on other occasions, it may absolutely not be. Some patients are very sneaky. What may start as one or two symptoms or signs of shock may rapidly progress to full on shockity shock and impending risk of full circulatory collapse, as any sign of shock signals that the body is no longer able to sufficiently compensate for the lack of oxygen reaching the end organs. When it comes to decompensation, it is a slippery slope, so heed any warning and respect its authoritah. "SHOCR" symptoms and signs of real-deal shock:
Early signs of circulatory compromise (or pre-shock) for which the body may still be compensating include:
It is also important to know that there are different types of shock, and that not all types present with all of the above features. This is another reason to have a high index of suspicion for shock or at least circulatory impairment when noticing the presence of any of the above symptoms or signs. These signs are also not specific, and may indicate other disease processes (ex: tachycardia in the setting of fever without circulatory compromise per se), but it is important to consider shock or impending shock on the differential to be able to react sooner rather than later if indicated. Shock is generally classified as being 1 of 4 types, and it helps to narrow down the type of shock based on clues from the primary examination (if possible, but it's important to know that more than one process can be co-occuring) to determine more quickly the underlying etiology and provide definite treatment ASAP.
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