The Patient in Shock

  • Martin W. DünserEmail author
  • Daniel Dankl


Shock is a life-threatening, generalized form of acute circulatory failure associated with inadequate oxygen utilization by the cells [1]. 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).


  1. 1.
    Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, Jaeschke R, Mebazaa A, Pinsky MR, Teboul JL, Vincent JL, Rhodes A (2014) Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 40:1795–1815CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ait-Oufella H, Lemoinne S, Boelle PY, Galbois A, Baudel JL, Lemant J, Joffre J, Margetis D, Guidet B, Maury E, Offenstadt G (2011) Mottling score predicts survival in septic shock. Intensive Care Med 37:801–807CrossRefPubMedGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Intensive Care MedicineKepler University Hospital, Johannes Kepler University LinzLinzAustria
  2. 2.Department of Anesthesiology, Perioperative Medicine and General Intensive CareSalzburg University Hospital and Paracelsus Private Medical UniversitySalzburgAustria

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