[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Cardiovascular system](https://durgical.com/en/clinical-exam/#a-cardiovascular) › Shock: the clinical signs and the types [Clinical exam](https://durgical.com/en/clinical-exam/) · [Cardiovascular system](https://durgical.com/en/clinical-exam/#a-cardiovascular) # Shock: the clinical signs and the types - Syndrome Shock means the blood cannot deliver enough oxygen to the organs; it shows in the skin, the mind, the urine and the pulse. Updated 2026-11-01 **See it in 3D:** [Left ventricle](https://durgical.com/en/anatomy/left-ventricle/) · [Inferior vena cava](https://durgical.com/en/anatomy/inferior-vena-cava/) · [Pericardium](https://durgical.com/en/anatomy/pericardium/) ## Key points - Hypotension is late: tachycardia, cool skin, slow capillary refill, oliguria and confusion come first. - Four types: hypovolemic, cardiogenic, obstructive and distributive. - High neck veins = cardiogenic or obstructive; flat = hypovolemic or distributive. - Neurogenic: hypotension with bradycardia and warm skin. ## What it is Shock is acute circulatory failure with tissue hypoperfusion. Hypotension can come late: the first signs are tachycardia, cool skin, slow capillary refill, oliguria and confusion. Examining the neck veins, lungs and skin points to the type. ## Key findings - Hypotension: systolic below 90 mmHg or mean arterial pressure below 65 mmHg, or a marked fall from baseline. - Tachycardia, weak pulse, tachypnea, capillary refill over 2 seconds, cool, pale, sweaty or mottled skin. - Oliguria (less than half a milliliter of urine per kilogram per hour) and altered mental status. - Shock index (heart rate / systolic pressure) above 1: hypoperfusion likely. - Flat neck veins: hypovolemic or distributive. Distended neck veins: cardiogenic or obstructive. Crackles: cardiogenic. Warm skin early: septic. ## Pathophysiology - Blood pressure = cardiac output times vascular resistance; shock appears when one falls and the other cannot compensate. - Hypovolemic: not enough volume (bleeding, dehydration). Cardiogenic: the pump fails. Obstructive: something blocks filling or outflow (tamponade, tension pneumothorax, massive embolism). - Distributive: vasodilation with maldistributed flow (septic, anaphylactic, neurogenic). - The sympathetic response gives tachycardia, vasoconstriction and cool skin; anaerobic metabolism raises lactate. ## Common causes - Hypovolemic: bleeding from trauma, the gut or childbirth; diarrhea and vomiting; burns. - Cardiogenic: large infarction, arrhythmias, myocarditis, acute valve disease. - Obstructive: cardiac tamponade, tension pneumothorax, massive pulmonary embolism. - Distributive: sepsis, anaphylaxis, spinal cord injury (neurogenic, with bradycardia and warm skin). ## Tests that confirm it - Raised lactate; arterial blood gas with metabolic acidosis. - Bedside ultrasound: cardiac function, pericardial effusion, vena cava, pneumothorax. - Beta-blockers, pacemakers and old age can mask tachycardia; children and young adults keep their blood pressure until late. ## Test yourself Think of the answer, then tap the question to see it. ## Which types of shock present with distended neck veins? Cardiogenic and obstructive (tamponade, tension pneumothorax, massive embolism). ## Why is hypotension a late sign of hemorrhagic shock? Tachycardia and vasoconstriction hold blood pressure up until a large part of the volume is lost. ## Which combination of signs suggests neurogenic shock? Hypotension with bradycardia and warm, dry skin after a high spinal cord injury. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/clinical-exam/shock-the-clinical-signs-and-the-types/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Left ventricle](https://durgical.com/en/anatomy/left-ventricle/) - [Inferior vena cava](https://durgical.com/en/anatomy/inferior-vena-cava/) - [Pericardium](https://durgical.com/en/anatomy/pericardium/) ## Related - [Cardiac tamponade: Beck triad and pulsus paradoxus](https://durgical.com/en/clinical-exam/cardiac-tamponade-beck-triad-and-pulsus-paradoxus/) - [Capillary refill time](https://durgical.com/en/clinical-exam/capillary-refill-time/) - [Blood pressure measurement](https://durgical.com/en/clinical-exam/blood-pressure-measurement/) - [Arterial pulse: rate, rhythm and amplitude](https://durgical.com/en/clinical-exam/arterial-pulse-rate-rhythm-and-amplitude/) - [Jugular venous pressure and the venous pulse](https://durgical.com/en/clinical-exam/jugular-venous-pressure-and-the-venous-pulse/) - [Fever, infection and sepsis: the bedside signs](https://durgical.com/en/clinical-exam/fever-infection-and-sepsis-the-bedside-signs/) - [Pallor, cyanosis and jaundice](https://durgical.com/en/clinical-exam/pallor-cyanosis-and-jaundice/) ## Related conditions - [Hypovolaemic shock](https://durgical.com/en/conditions/hypovolaemic-shock/) - [Cardiogenic shock](https://durgical.com/en/conditions/cardiogenic-shock/) - [Sepsis and septic shock](https://durgical.com/en/conditions/sepsis-and-septic-shock/) - [Cardiac tamponade](https://durgical.com/en/conditions/cardiac-tamponade/) - [Pulmonary embolism](https://durgical.com/en/conditions/pulmonary-embolism/) - [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Sources: [Shock: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000039.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [Cardiac tamponade: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000194.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [24.3 Nursing Assessment - Clinical Nursing Skills | OpenStax](https://openstax.org/books/clinical-nursing-skills/pages/24-3-nursing-assessment) (OpenStax (Rice University), 2024). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/shock-the-clinical-signs-and-the-types/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/shock-the-clinical-signs-and-the-types/