The Patient in Shock
Shock is a life-threatening, generalized form of acute circulatory failure associated with inadequate oxygen utilization by the cells . Many clinicians still falsely believe that the presence of arterial hypotension is required to diagnose shock. Although arterial hypotension is frequently (but not always) a clinical sign of (severe) shock, a substantial percentage of patients in shock present with normo- or even hypertensive arterial blood pressure values. The recognition of shock is, therefore, largely based on the clinical examination. Based on the results of the clinical examination, two characteristic presentations can be differentiated: (1) inadequate systemic blood flow (hypovolaemia, heart failure, obstruction) and (2) maintained or increased systemic blood flow (excessive vasodilatation). A structured head-to-toe examination is elemental to distinguish between these subtypes of shock and assess the severity of tissue hypoperfusion (Tables 14.1, 14.2 and 14.3).
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