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Learn to Identify Sick Patients

NextGen Learning To Elevate Your Airway Practice

IntroductionSigns of Shock
Key FindingsWhat’s Next

To address shock in the peri-intubation period, you need to know how to identify it, differentiate it, and then be able to intervene upon it appropriately. The inadequate supply of blood and oxygen to the body’s tissues and organs that define shock often requires securing the airway, but this is only one aspect of the larger picture. Without understanding the positive and negative impacts your airway interventions can have on your overall resuscitation efforts, you may find yourself and your patient in unintended difficulty. Use this space to review key shock features to help you identify them.

Type of Shock

It is crucial to determine the type of shock your patient is experiencing before intubation because different kinds of shock have distinct hemodynamic profiles. Understanding the underlying shock type allows for appropriate pre-intubation optimization and prevention of worsening hypotension or cardiac arrest.

  • Hypovolemic shock: Caused by low blood volume.
  • Cardiogenic shock: Caused by Cardiac dysfunction
  • Obstructive shock: Causes such as a pulmonary embolism or tension pneumothorax that prevents the heart from pumping enough blood.
  • Distributive shock: A state of relative hypovolemia, with subtypes including septic shock, neurogenic shock, and anaphylactic shock

Signs of Shock

Recognizing the clinical features and signs of shock is a critical skill. Shock is not just a single event but a progressive, life-threatening condition that demands immediate attention. Whether caused by trauma, infection, cardiac failure, or other systemic insults, its early identification allows for timely intervention, preventing irreversible organ damage and improving patient outcomes. The challenge lies in its often subtle or evolving presentation—what starts as mild tachycardia or cool extremities can quickly spiral into hemodynamic collapse. Mastering the ability to detect shock before intubation in its earliest stages empowers clinicians to act decisively, optimizing resuscitation efforts and ultimately saving lives.

Significant Clinical Findings of Shock

1. General Signs & Symptoms

  • Altered mental status (confusion, restlessness, agitation, or unresponsiveness)
  • Weakness, fatigue, or dizziness
  • Anxiety or feeling of impending doom

2. Cardiovascular Findings

  • Hypotension (low blood pressure, often <90 mmHg systolic)
  • Tachycardia (increased heart rate, usually >100 bpm)
  • Weak, thready pulse (or bounding pulse in early septic shock)
  • Cool, clammy skin (except in distributive shock where skin may be warm)
  • Delayed capillary refill (>2 seconds)

3. Respiratory Findings

  • Tachypnea (rapid breathing, often >20 breaths per minute)
  • Shallow respirations
  • Signs of respiratory distress (use of accessory muscles, nasal flaring)
  • Hypoxia (low oxygen saturation, cyanosis in severe cases)

4. Skin & Extremities

  • Pale, mottled, or cyanotic skin
  • Sweating (diaphoresis)
  • Cold extremities (except in distributive shock)

5. Urinary Findings

  • Oliguria (low urine output, <0.5 mL/kg/hr)
  • Anuria (absence of urine output in severe cases)

6. Metabolic Findings

  • Metabolic acidosis (due to lactic acidosis)
  • Hyperlactatemia (elevated serum lactate >2 mmol/L)

Clinical Pearl

What’s Next

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