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Chest X-Ray - may show signs of infection or fluid build-up [11] or enlarged heart [14] Electrocardiogram - check for heart dysfunction [3] Echocardiogram - may show signs of left ventricular muscle thickening due to heart failure [14] CT Head - may show signs of stroke [3] CT-Angiogram - evaluate for signs of aortic dissection [3]
Hypothermia due to decreased perfusion and evaporation of sweat; Thirst and dry mouth, due to fluid depletion; Cold and mottled skin (livedo reticularis), especially extremities, due to insufficient perfusion of the skin; The severity of hemorrhagic shock can be graded on a 1–4 scale on the physical signs.
The signs and symptoms of ischemia vary, as they can occur anywhere in the body and depend on the degree to which blood flow is interrupted. [4] For example, clinical manifestations of acute limb ischemia (which can be summarized as the "six P's") include pain, pallor, pulseless, paresthesia, paralysis, and poikilothermia.
The aim is to achieve a systolic blood pressure of 90 mmHg in order to maintain tissue perfusion without inducing re-bleeding from recently clotted vessels. Permissive hypotension is a means of restricting fluid administration until hemorrhage is controlled while accepting a short period of suboptimal end-organ perfusion.
Hypovolemia can be recognized by a fast heart rate, low blood pressure, [12] and the absence of perfusion as assessed by skin signs (skin turning pale) and/or capillary refill on forehead, lips and nail beds. The patient may feel dizzy, faint, nauseated, or very thirsty. These signs are also characteristic of most types of shock. [13]
The cause of inadequate tissue perfusion (blood delivery to tissues) in distributive shock is a lack of normal responsiveness of blood vessels to vasoconstrictive agents and direct vasodilation. [4] There are four types of distributive shock.
Individuals with poor kidney perfusion are especially at risk for kidney impairment inherent with these medications. [15] Beta-blockers. Beta-blockers are stopped or decreased in people with acutely decompensated heart failure and a low blood pressure. However, continuation of beta-blockers may be appropriate if the blood pressure is adequate. [16]
Because of poor blood flow to the tissues, patients may have cold extremities. Less blood to the kidneys and brain can cause decreased urine output and altered mental status, respectively. [9] Other signs may be seen depending on the underlying cause. For example, jugular venous distension is a significant finding in evaluating shock.