How is it Diagnosed?
Shock is a critical condition marked by inadequate tissue perfusion, resulting in cellular
hypoxia and organ dysfunction. It can be classified into hypovolemic, cardiogenic,
distributive (e.g., septic, anaphylactic), and obstructive types. Diagnosis hinges on
clinical assessment and prompt identification of the underlying cause.
Initial signs include hypotension (systolic BP <90 mmHg or MAP <65 mmHg),
tachycardia, cold and clammy skin (except in distributive shock), altered mental status,
decreased urine output, and metabolic acidosis (lactic acidosis).
A detailed history (trauma, infection, allergies, cardiac disease) and physical exam guide
further evaluation. Clinical features vary: for example, in hypovolemic shock, there's dry
skin and flat neck veins; in cardiogenic shock, signs include pulmonary edema and
distended neck veins; in septic shock, warm skin and bounding pulses may be seen
initially.
Laboratory workup includes CBC, electrolytes, arterial blood gas (ABG), lactate, renal
and liver function tests, and coagulation profile. Elevated lactate (>2 mmol/L) is a key
indicator of tissue hypoxia.
Imaging studies such as chest X-ray, echocardiography, abdominal ultrasound, and CT
scans may help identify internal bleeding, cardiac function, or septic foci.
Bedside tools like point-of-care ultrasound (POCUS) are invaluable for rapid assessment
of volume status, cardiac function, and pericardial tamponade. Prompt recognition and
classification of the shock type are essential for initiating targeted therapy.