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class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Distributive"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.4</span> <span>Distributive</span> </div> </a> <ul id="toc-Distributive-sublist" class="vector-toc-list"> <li id="toc-Endocrine" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Endocrine"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.4.1</span> <span>Endocrine</span> </div> </a> <ul id="toc-Endocrine-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> </ul> </li> <li id="toc-Cause" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Cause"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Cause</span> </div> </a> <ul id="toc-Cause-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pathophysiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Pathophysiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Pathophysiology</span> </div> </a> <button aria-controls="toc-Pathophysiology-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Pathophysiology subsection</span> </button> <ul id="toc-Pathophysiology-sublist" class="vector-toc-list"> <li id="toc-Initial" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Initial"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>Initial</span> </div> </a> <ul id="toc-Initial-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Compensatory" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Compensatory"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>Compensatory</span> </div> </a> <ul id="toc-Compensatory-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Progressive/decompensated" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Progressive/decompensated"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.3</span> <span>Progressive/decompensated</span> </div> </a> <ul id="toc-Progressive/decompensated-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Refractory" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Refractory"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.4</span> <span>Refractory</span> </div> </a> <ul id="toc-Refractory-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Diagnosis</span> </div> </a> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Management" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Management"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Management</span> </div> </a> <button aria-controls="toc-Management-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Management subsection</span> </button> <ul id="toc-Management-sublist" class="vector-toc-list"> <li id="toc-Fluids" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Fluids"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Fluids</span> </div> </a> <ul id="toc-Fluids-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Medications" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Medications"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Medications</span> </div> </a> <ul id="toc-Medications-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Mechanical_support" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Mechanical_support"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.3</span> <span>Mechanical support</span> </div> </a> <ul id="toc-Mechanical_support-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Treatment_goals" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Treatment_goals"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.4</span> <span>Treatment goals</span> </div> </a> <ul id="toc-Treatment_goals-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Epidemiology</span> </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Prognosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Prognosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Prognosis</span> </div> </a> <ul id="toc-Prognosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>History</span> </div> </a> <ul id="toc-History-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Shock (circulatory)</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" 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Available in 65 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-65" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">65 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%B5%D8%AF%D9%85%D8%A9_(%D8%AC%D9%87%D8%A7%D8%B2_%D8%A7%D9%84%D8%AF%D9%88%D8%B1%D8%A7%D9%86)" title="صدمة (جهاز الدوران) – Arabic" lang="ar" hreflang="ar" data-title="صدمة (جهاز الدوران)" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-ast mw-list-item"><a href="https://ast.wikipedia.org/wiki/Choque_circulatoriu" title="Choque circulatoriu – Asturian" lang="ast" hreflang="ast" data-title="Choque circulatoriu" data-language-autonym="Asturianu" data-language-local-name="Asturian" class="interlanguage-link-target"><span>Asturianu</span></a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/%C5%9Eok" title="Şok – Azerbaijani" lang="az" hreflang="az" data-title="Şok" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target"><span>Azərbaycanca</span></a></li><li class="interlanguage-link interwiki-zh-min-nan mw-list-item"><a href="https://zh-min-nan.wikipedia.org/wiki/Hiu-khek" title="Hiu-khek – Minnan" lang="nan" hreflang="nan" data-title="Hiu-khek" data-language-autonym="閩南語 / Bân-lâm-gú" data-language-local-name="Minnan" class="interlanguage-link-target"><span>閩南語 / Bân-lâm-gú</span></a></li><li class="interlanguage-link interwiki-be mw-list-item"><a href="https://be.wikipedia.org/wiki/%D0%A8%D0%BE%D0%BA" title="Шок – Belarusian" lang="be" hreflang="be" data-title="Шок" data-language-autonym="Беларуская" data-language-local-name="Belarusian" class="interlanguage-link-target"><span>Беларуская</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%A8%D0%BE%D0%BA" title="Шок – Bulgarian" lang="bg" hreflang="bg" data-title="Шок" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/%C5%A0ok_(medicina)" title="Šok (medicina) – Bosnian" lang="bs" hreflang="bs" data-title="Šok (medicina)" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target"><span>Bosanski</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Xoc_(circulatori)" title="Xoc (circulatori) – Catalan" lang="ca" hreflang="ca" data-title="Xoc (circulatori)" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/%C5%A0ok_(ob%C4%9Bhov%C3%A9_selh%C3%A1n%C3%AD)" title="Šok (oběhové selhání) – Czech" lang="cs" hreflang="cs" data-title="Šok (oběhové selhání)" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Shock" title="Shock – Danish" lang="da" hreflang="da" data-title="Shock" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target"><span>Dansk</span></a></li><li class="interlanguage-link interwiki-de badge-Q17437798 badge-goodarticle mw-list-item" title="good article badge"><a href="https://de.wikipedia.org/wiki/Schock_(Medizin)" title="Schock (Medizin) – German" lang="de" hreflang="de" data-title="Schock (Medizin)" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/%C5%A0okk" title="Šokk – Estonian" lang="et" hreflang="et" data-title="Šokk" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target"><span>Eesti</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%9A%CE%B1%CF%84%CE%B1%CF%80%CE%BB%CE%B7%CE%BE%CE%AF%CE%B1" title="Καταπληξία – Greek" lang="el" hreflang="el" data-title="Καταπληξία" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Choque_circulatorio" title="Choque circulatorio – Spanish" lang="es" hreflang="es" data-title="Choque circulatorio" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Shock_zirkulatorio" title="Shock zirkulatorio – Basque" lang="eu" hreflang="eu" data-title="Shock zirkulatorio" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%B4%D9%88%DA%A9_(%D8%A7%D9%81%D8%AA_%D9%81%D8%B4%D8%A7%D8%B1_%D8%AE%D9%88%D9%86)" title="شوک (افت فشار خون) – Persian" lang="fa" hreflang="fa" data-title="شوک (افت فشار خون)" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/%C3%89tat_de_choc_circulatoire" title="État de choc circulatoire – French" lang="fr" hreflang="fr" data-title="État de choc circulatoire" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Choque" title="Choque – Galician" lang="gl" hreflang="gl" data-title="Choque" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target"><span>Galego</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EC%87%BC%ED%81%AC" title="쇼크 – Korean" lang="ko" hreflang="ko" data-title="쇼크" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-ha mw-list-item"><a href="https://ha.wikipedia.org/wiki/Girgiza_(hanzari)" title="Girgiza (hanzari) – Hausa" lang="ha" hreflang="ha" data-title="Girgiza (hanzari)" data-language-autonym="Hausa" data-language-local-name="Hausa" class="interlanguage-link-target"><span>Hausa</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%87%D5%B8%D5%AF" title="Շոկ – Armenian" lang="hy" hreflang="hy" data-title="Շոկ" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%B6%E0%A5%89%E0%A4%95" title="शॉक – Hindi" lang="hi" hreflang="hi" data-title="शॉक" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target"><span>हिन्दी</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/%C5%A0ok_(medicina)" title="Šok (medicina) – Croatian" lang="hr" hreflang="hr" data-title="Šok (medicina)" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Syok" title="Syok – Indonesian" lang="id" hreflang="id" data-title="Syok" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Shock" title="Shock – Italian" lang="it" hreflang="it" data-title="Shock" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%94%D7%9C%D7%9D" title="הלם – Hebrew" lang="he" hreflang="he" data-title="הלם" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-ka mw-list-item"><a href="https://ka.wikipedia.org/wiki/%E1%83%A8%E1%83%9D%E1%83%99%E1%83%98" title="შოკი – Georgian" lang="ka" hreflang="ka" data-title="შოკი" data-language-autonym="ქართული" data-language-local-name="Georgian" class="interlanguage-link-target"><span>ქართული</span></a></li><li class="interlanguage-link interwiki-kk mw-list-item"><a href="https://kk.wikipedia.org/wiki/%D0%A2%D0%B0%D0%BB%D1%8B%D2%9B%D1%81%D1%83" title="Талықсу – Kazakh" lang="kk" hreflang="kk" data-title="Талықсу" data-language-autonym="Қазақша" data-language-local-name="Kazakh" class="interlanguage-link-target"><span>Қазақша</span></a></li><li class="interlanguage-link interwiki-ky mw-list-item"><a href="https://ky.wikipedia.org/wiki/%D0%A8%D0%BE%D0%BA" title="Шок – Kyrgyz" lang="ky" hreflang="ky" data-title="Шок" data-language-autonym="Кыргызча" data-language-local-name="Kyrgyz" class="interlanguage-link-target"><span>Кыргызча</span></a></li><li class="interlanguage-link interwiki-la mw-list-item"><a href="https://la.wikipedia.org/wiki/Ictus_(circulatorius)" title="Ictus (circulatorius) – Latin" lang="la" hreflang="la" data-title="Ictus (circulatorius)" data-language-autonym="Latina" data-language-local-name="Latin" class="interlanguage-link-target"><span>Latina</span></a></li><li class="interlanguage-link interwiki-lv mw-list-item"><a href="https://lv.wikipedia.org/wiki/%C5%A0oks" title="Šoks – Latvian" lang="lv" hreflang="lv" data-title="Šoks" data-language-autonym="Latviešu" data-language-local-name="Latvian" class="interlanguage-link-target"><span>Latviešu</span></a></li><li class="interlanguage-link interwiki-lt mw-list-item"><a href="https://lt.wikipedia.org/wiki/%C5%A0okas" title="Šokas – Lithuanian" lang="lt" hreflang="lt" data-title="Šokas" data-language-autonym="Lietuvių" data-language-local-name="Lithuanian" class="interlanguage-link-target"><span>Lietuvių</span></a></li><li class="interlanguage-link interwiki-lij mw-list-item"><a href="https://lij.wikipedia.org/wiki/Shock" title="Shock – Ligurian" lang="lij" hreflang="lij" data-title="Shock" data-language-autonym="Ligure" data-language-local-name="Ligurian" class="interlanguage-link-target"><span>Ligure</span></a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Sokk" title="Sokk – Hungarian" lang="hu" hreflang="hu" data-title="Sokk" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target"><span>Magyar</span></a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%A8%D0%BE%D0%BA" title="Шок – Macedonian" lang="mk" hreflang="mk" data-title="Шок" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target"><span>Македонски</span></a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Renjatan_(peredaran)" title="Renjatan (peredaran) – Malay" lang="ms" hreflang="ms" data-title="Renjatan (peredaran)" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target"><span>Bahasa Melayu</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Shock" title="Shock – Dutch" lang="nl" hreflang="nl" data-title="Shock" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E3%82%B7%E3%83%A7%E3%83%83%E3%82%AF" title="ショック – Japanese" lang="ja" hreflang="ja" data-title="ショック" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Sjokk" title="Sjokk – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Sjokk" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk bokmål</span></a></li><li class="interlanguage-link interwiki-nn mw-list-item"><a href="https://nn.wikipedia.org/wiki/Sirkulatorisk_sjokk" title="Sirkulatorisk sjokk – Norwegian Nynorsk" lang="nn" hreflang="nn" data-title="Sirkulatorisk sjokk" data-language-autonym="Norsk nynorsk" data-language-local-name="Norwegian Nynorsk" class="interlanguage-link-target"><span>Norsk nynorsk</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%B6%E0%AC%95%E0%AD%8D_(%E0%AC%B0%E0%AC%95%E0%AD%8D%E0%AC%A4_%E0%AC%B8%E0%AC%9E%E0%AD%8D%E0%AC%9A%E0%AC%BE%E0%AC%B3%E0%AC%A8)" title="ଶକ୍ (ରକ୍ତ ସଞ୍ଚାଳନ) – Odia" lang="or" hreflang="or" data-title="ଶକ୍ (ରକ୍ତ ସଞ୍ଚାଳନ)" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-jam mw-list-item"><a href="https://jam.wikipedia.org/wiki/Shak" title="Shak – Jamaican Creole English" lang="jam" hreflang="jam" data-title="Shak" data-language-autonym="Patois" data-language-local-name="Jamaican Creole English" class="interlanguage-link-target"><span>Patois</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Wstrz%C4%85s" title="Wstrząs – Polish" lang="pl" hreflang="pl" data-title="Wstrząs" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Choque_circulat%C3%B3rio" title="Choque circulatório – Portuguese" lang="pt" hreflang="pt" data-title="Choque circulatório" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/%C8%98oc_(medicin%C4%83)" title="Șoc (medicină) – Romanian" lang="ro" hreflang="ro" data-title="Șoc (medicină)" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target"><span>Română</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%A8%D0%BE%D0%BA" title="Шок – Russian" lang="ru" hreflang="ru" data-title="Шок" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-sah mw-list-item"><a href="https://sah.wikipedia.org/wiki/%D0%A8%D0%BE%D0%BA" title="Шок – Yakut" lang="sah" hreflang="sah" data-title="Шок" data-language-autonym="Саха тыла" data-language-local-name="Yakut" class="interlanguage-link-target"><span>Саха тыла</span></a></li><li class="interlanguage-link interwiki-sq mw-list-item"><a href="https://sq.wikipedia.org/wiki/Gjendja_e_shokut" title="Gjendja e shokut – Albanian" lang="sq" hreflang="sq" data-title="Gjendja e shokut" data-language-autonym="Shqip" data-language-local-name="Albanian" class="interlanguage-link-target"><span>Shqip</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Shock_(circulatory)" title="Shock (circulatory) – Simple English" lang="en-simple" hreflang="en-simple" data-title="Shock (circulatory)" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target"><span>Simple English</span></a></li><li class="interlanguage-link interwiki-sk mw-list-item"><a href="https://sk.wikipedia.org/wiki/%C5%A0ok_(medic%C3%ADna)" title="Šok (medicína) – Slovak" lang="sk" hreflang="sk" data-title="Šok (medicína)" data-language-autonym="Slovenčina" data-language-local-name="Slovak" class="interlanguage-link-target"><span>Slovenčina</span></a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/%C5%A0ok" title="Šok – Slovenian" lang="sl" hreflang="sl" data-title="Šok" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target"><span>Slovenščina</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%A8%D0%BE%D0%BA_(%D0%BC%D0%B5%D0%B4%D0%B8%D1%86%D0%B8%D0%BD%D0%B0)" title="Шок (медицина) – Serbian" lang="sr" hreflang="sr" data-title="Шок (медицина)" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/%C5%A0ok_(medicina)" title="Šok (medicina) – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Šok (medicina)" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/%C5%A0okki" title="Šokki – Finnish" lang="fi" hreflang="fi" data-title="Šokki" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Cirkulationssvikt" title="Cirkulationssvikt – Swedish" lang="sv" hreflang="sv" data-title="Cirkulationssvikt" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-ta mw-list-item"><a href="https://ta.wikipedia.org/wiki/%E0%AE%85%E0%AE%A4%E0%AE%BF%E0%AE%B0%E0%AF%8D%E0%AE%9A%E0%AF%8D%E0%AE%9A%E0%AE%BF_(%E0%AE%AE%E0%AE%B0%E0%AF%81%E0%AE%A4%E0%AF%8D%E0%AE%A4%E0%AF%81%E0%AE%B5%E0%AE%AE%E0%AF%8D)" title="அதிர்ச்சி (மருத்துவம்) – Tamil" lang="ta" hreflang="ta" data-title="அதிர்ச்சி (மருத்துவம்)" data-language-autonym="தமிழ்" data-language-local-name="Tamil" class="interlanguage-link-target"><span>தமிழ்</span></a></li><li class="interlanguage-link interwiki-tt mw-list-item"><a href="https://tt.wikipedia.org/wiki/%D0%A8%D0%BE%D0%BA" title="Шок – Tatar" lang="tt" hreflang="tt" data-title="Шок" data-language-autonym="Татарча / tatarça" data-language-local-name="Tatar" class="interlanguage-link-target"><span>Татарча / tatarça</span></a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B8%8A%E0%B9%87%E0%B8%AD%E0%B8%81" title="ช็อก – Thai" lang="th" hreflang="th" data-title="ช็อก" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target"><span>ไทย</span></a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/%C5%9Eok_(dola%C5%9F%C4%B1m)" title="Şok (dolaşım) – Turkish" lang="tr" hreflang="tr" data-title="Şok (dolaşım)" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target"><span>Türkçe</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%A8%D0%BE%D0%BA_(%D0%BC%D0%B5%D0%B4%D0%B8%D1%86%D0%B8%D0%BD%D0%B0)" title="Шок (медицина) – Ukrainian" lang="uk" hreflang="uk" data-title="Шок (медицина)" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target"><span>Українська</span></a></li><li class="interlanguage-link interwiki-ug mw-list-item"><a href="https://ug.wikipedia.org/wiki/%D8%B4%D9%88%D9%83" title="شوك – Uyghur" lang="ug" hreflang="ug" data-title="شوك" data-language-autonym="ئۇيغۇرچە / Uyghurche" data-language-local-name="Uyghur" class="interlanguage-link-target"><span>ئۇيغۇرچە / Uyghurche</span></a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/S%E1%BB%91c_tu%E1%BA%A7n_ho%C3%A0n" title="Sốc tuần hoàn – Vietnamese" lang="vi" hreflang="vi" data-title="Sốc tuần hoàn" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" 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free encyclopedia</div> </div> <div id="contentSub"><div id="mw-content-subtitle"></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition of insufficient blood flow</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">For other uses, see <a href="/wiki/Shock_(disambiguation)" class="mw-redirect mw-disambig" title="Shock (disambiguation)">Shock (disambiguation)</a>.</div><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Shock</th></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:US_Navy_120203-N-CD652-004_U.S._Naval_Hospital_Guantanamo_Bay_emergency_technician_(EMT)_trainees_work_with_Naval_Station_Guantanamo_Bay_firemen_to.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b6/US_Navy_120203-N-CD652-004_U.S._Naval_Hospital_Guantanamo_Bay_emergency_technician_%28EMT%29_trainees_work_with_Naval_Station_Guantanamo_Bay_firemen_to.jpg/220px-US_Navy_120203-N-CD652-004_U.S._Naval_Hospital_Guantanamo_Bay_emergency_technician_%28EMT%29_trainees_work_with_Naval_Station_Guantanamo_Bay_firemen_to.jpg" decoding="async" width="220" height="157" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b6/US_Navy_120203-N-CD652-004_U.S._Naval_Hospital_Guantanamo_Bay_emergency_technician_%28EMT%29_trainees_work_with_Naval_Station_Guantanamo_Bay_firemen_to.jpg/330px-US_Navy_120203-N-CD652-004_U.S._Naval_Hospital_Guantanamo_Bay_emergency_technician_%28EMT%29_trainees_work_with_Naval_Station_Guantanamo_Bay_firemen_to.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b6/US_Navy_120203-N-CD652-004_U.S._Naval_Hospital_Guantanamo_Bay_emergency_technician_%28EMT%29_trainees_work_with_Naval_Station_Guantanamo_Bay_firemen_to.jpg/440px-US_Navy_120203-N-CD652-004_U.S._Naval_Hospital_Guantanamo_Bay_emergency_technician_%28EMT%29_trainees_work_with_Naval_Station_Guantanamo_Bay_firemen_to.jpg 2x" data-file-width="2100" data-file-height="1500" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data"><a href="/wiki/United_States_Navy" title="United States Navy">US Navy</a> <a href="/wiki/Emergency_medical_technician" title="Emergency medical technician">EMT</a> trainees and firemen using <a href="/wiki/Intravenous_therapy" title="Intravenous therapy">IV fluid replacement</a> in treating a trauma training mannequin to prevent hypovolemic shock</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Critical_care_medicine" class="mw-redirect" title="Critical care medicine">Critical care medicine</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data"><b>Initial</b>: Weakness, fast heart rate, fast breathing, sweating, anxiety, increased thirst<sup id="cite_ref-ITLSPg172_1-0" class="reference"><a href="#cite_note-ITLSPg172-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><br /><b>Later</b>: Confusion, <a href="/wiki/Unconsciousness" title="Unconsciousness">unconsciousness</a>, <a href="/wiki/Cardiac_arrest" title="Cardiac arrest">cardiac arrest</a><sup id="cite_ref-ITLSPg172_1-1" class="reference"><a href="#cite_note-ITLSPg172-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Types</th><td class="infobox-data"><a href="/wiki/Hypovolemia#Stages_of_hypovolemic_shock" title="Hypovolemia">Low volume</a>, <a href="/wiki/Cardiogenic_shock" title="Cardiogenic shock">cardiogenic</a>, <a href="/wiki/Obstructive_shock" title="Obstructive shock">obstructive</a>, <a href="/wiki/Distributive_shock" title="Distributive shock">distributive</a><sup id="cite_ref-ATLS2018_2-0" class="reference"><a href="#cite_note-ATLS2018-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data"><b>Low volume</b>: Severe bleeding, vomiting, diarrhea, dehydration, or <a href="/wiki/Pancreatitis" title="Pancreatitis">pancreatitis</a><sup id="cite_ref-ITLSPg172_1-2" class="reference"><a href="#cite_note-ITLSPg172-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><br /><b>Cardiogenic</b>: severe <a href="/wiki/Heart_attack" class="mw-redirect" title="Heart attack">heart attack</a> (especially of the left or right ventricles), severe <a href="/wiki/Heart_failure" title="Heart failure">heart failure</a>, <a href="/wiki/Cardiac_contusion" class="mw-redirect" title="Cardiac contusion">cardiac contusion</a><sup id="cite_ref-ITLSPg172_1-3" class="reference"><a href="#cite_note-ITLSPg172-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><br /><b>Obstructive</b>: <a href="/wiki/Cardiac_tamponade" title="Cardiac tamponade">Cardiac tamponade</a>, <a href="/wiki/Tension_pneumothorax" class="mw-redirect" title="Tension pneumothorax">tension pneumothorax</a><sup id="cite_ref-ITLSPg172_1-4" class="reference"><a href="#cite_note-ITLSPg172-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><br /><b>Distributive</b>: <a href="/wiki/Sepsis" title="Sepsis">Sepsis</a>, <a href="/wiki/Spinal_cord_injury" title="Spinal cord injury">spinal cord injury</a>, certain <a href="/wiki/Overdose" class="mw-redirect" title="Overdose">overdoses</a><sup id="cite_ref-ITLSPg172_1-5" class="reference"><a href="#cite_note-ITLSPg172-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Based on symptoms, <a href="/wiki/Physical_exam" class="mw-redirect" title="Physical exam">physical exam</a>, laboratory tests<sup id="cite_ref-ATLS2018_2-1" class="reference"><a href="#cite_note-ATLS2018-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data">Based on the underlying cause<sup id="cite_ref-ATLS2018_2-2" class="reference"><a href="#cite_note-ATLS2018-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medication" title="Medication">Medication</a></th><td class="infobox-data"><a href="/wiki/Intravenous_fluid" class="mw-redirect" title="Intravenous fluid">Intravenous fluid</a>, <a href="/wiki/Vasopressors" class="mw-redirect" title="Vasopressors">vasopressors</a><sup id="cite_ref-ATLS2018_2-3" class="reference"><a href="#cite_note-ATLS2018-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Prognosis" title="Prognosis">Prognosis</a></th><td class="infobox-data">Risk of death 20 to 50%<sup id="cite_ref-Tab2010_3-0" class="reference"><a href="#cite_note-Tab2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">1.2 million per year (US)<sup id="cite_ref-Tab2010_3-1" class="reference"><a href="#cite_note-Tab2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></td></tr></tbody></table> <p><b>Shock</b> is the state of insufficient <a href="/wiki/Blood_flow" class="mw-redirect" title="Blood flow">blood flow</a> to the <a href="/wiki/Tissue_(biology)" title="Tissue (biology)">tissues</a> of the body as a result of problems with the <a href="/wiki/Circulatory_system" title="Circulatory system">circulatory system</a>. Initial symptoms of shock may include weakness, <a href="/wiki/Tachycardia" title="Tachycardia">tachycardia</a>, <a href="/wiki/Hyperventilation" title="Hyperventilation">hyperventilation</a>, <a href="/wiki/Sweating" class="mw-redirect" title="Sweating">sweating</a>, anxiety, and increased thirst.<sup id="cite_ref-ITLSPg172_1-6" class="reference"><a href="#cite_note-ITLSPg172-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> This may be followed by confusion, <a href="/wiki/Unconsciousness" title="Unconsciousness">unconsciousness</a>, or <a href="/wiki/Cardiac_arrest" title="Cardiac arrest">cardiac arrest</a>, as complications worsen.<sup id="cite_ref-ITLSPg172_1-7" class="reference"><a href="#cite_note-ITLSPg172-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Shock is divided into four main types based on the underlying cause: <a href="/wiki/Hypovolemic_shock" title="Hypovolemic shock">hypovolemic</a>, <a href="/wiki/Cardiogenic_shock" title="Cardiogenic shock">cardiogenic</a>, <a href="/wiki/Obstructive_shock" title="Obstructive shock">obstructive</a>, and <a href="/wiki/Distributive_shock" title="Distributive shock">distributive shock</a>.<sup id="cite_ref-ATLS2018_2-4" class="reference"><a href="#cite_note-ATLS2018-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Hypovolemic shock, also known as low volume shock, may be from bleeding, <a href="/wiki/Diarrhea" title="Diarrhea">diarrhea</a>, or vomiting.<sup id="cite_ref-ITLSPg172_1-8" class="reference"><a href="#cite_note-ITLSPg172-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Cardiogenic shock may be due to a <a href="/wiki/Heart_attack" class="mw-redirect" title="Heart attack">heart attack</a> or <a href="/wiki/Cardiac_contusion" class="mw-redirect" title="Cardiac contusion">cardiac contusion</a>.<sup id="cite_ref-ITLSPg172_1-9" class="reference"><a href="#cite_note-ITLSPg172-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Obstructive_shock" title="Obstructive shock">Obstructive shock</a> may be due to <a href="/wiki/Cardiac_tamponade" title="Cardiac tamponade">cardiac tamponade</a> or a <a href="/wiki/Tension_pneumothorax" class="mw-redirect" title="Tension pneumothorax">tension pneumothorax</a>.<sup id="cite_ref-ITLSPg172_1-10" class="reference"><a href="#cite_note-ITLSPg172-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Distributive shock may be due to <a href="/wiki/Sepsis" title="Sepsis">sepsis</a>, <a href="/wiki/Anaphylaxis" title="Anaphylaxis">anaphylaxis</a>, <a href="/wiki/Neurogenic_shock" title="Neurogenic shock">injury to the upper spinal cord</a>, or certain <a href="/wiki/Overdose" class="mw-redirect" title="Overdose">overdoses</a>.<sup id="cite_ref-ITLSPg172_1-11" class="reference"><a href="#cite_note-ITLSPg172-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Stat2019Dis_4-0" class="reference"><a href="#cite_note-Stat2019Dis-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p><p>The diagnosis is generally based on a combination of symptoms, <a href="/wiki/Physical_examination" title="Physical examination">physical examination</a>, and laboratory tests.<sup id="cite_ref-ATLS2018_2-5" class="reference"><a href="#cite_note-ATLS2018-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> A decreased <a href="/wiki/Pulse_pressure" title="Pulse pressure">pulse pressure</a> (<a href="/wiki/Systolic_blood_pressure" class="mw-redirect" title="Systolic blood pressure">systolic blood pressure</a> minus <a href="/wiki/Diastolic_blood_pressure" class="mw-redirect" title="Diastolic blood pressure">diastolic blood pressure</a>) or a fast heart rate raises concerns.<sup id="cite_ref-ITLSPg172_1-12" class="reference"><a href="#cite_note-ITLSPg172-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Shock is a medical emergency and requires urgent medical care. If shock is suspected, emergency help should be called immediately. While waiting for medical care, the individual should be, if safe, laid down (except in cases of suspected head or back injuries). The legs should be raised if possible, and the person should be kept warm. If the person is unresponsive, breathing should be monitored and CPR may need to be performed.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <style data-mw-deduplicate="TemplateStyles:r886046785">.mw-parser-output .toclimit-2 .toclevel-1 ul,.mw-parser-output .toclimit-3 .toclevel-2 ul,.mw-parser-output .toclimit-4 .toclevel-3 ul,.mw-parser-output .toclimit-5 .toclevel-4 ul,.mw-parser-output .toclimit-6 .toclevel-5 ul,.mw-parser-output .toclimit-7 .toclevel-6 ul{display:none}</style><div class="toclimit-3"><meta property="mw:PageProp/toc" /></div> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The presentation of shock is variable, with some people having only minimal symptoms such as confusion and weakness.<sup id="cite_ref-Tint10_6-0" class="reference"><a href="#cite_note-Tint10-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> While the general signs for all types of shock are <a href="/wiki/Hypotension" title="Hypotension">low blood pressure</a>, decreased <a href="/wiki/Urine_output" class="mw-redirect" title="Urine output">urine output</a>, and confusion, these may not always be present.<sup id="cite_ref-Tint10_6-1" class="reference"><a href="#cite_note-Tint10-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> While a fast heart rate is common, in those on <a href="/wiki/Beta_blocker" title="Beta blocker">β-blockers</a>, those who are athletic, and in 30% of cases of those with shock due to intra abdominal bleeding, heart rate may be normal or slow.<sup id="cite_ref-Tint10,2_7-0" class="reference"><a href="#cite_note-Tint10,2-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Specific subtypes of shock may have additional symptoms.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup> </p><p>Dry <a href="/wiki/Mucous_membranes" class="mw-redirect" title="Mucous membranes">mucous membrane</a>, reduced <a href="/wiki/Skin_turgor" title="Skin turgor">skin turgor</a>, prolonged <a href="/wiki/Capillary_refill_time" class="mw-redirect" title="Capillary refill time">capillary refill time</a>, weak peripheral pulses, and cold extremities can be early signs of shock.<sup id="cite_ref-Centre_(UK)_8-0" class="reference"><a href="#cite_note-Centre_(UK)-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Low_volume">Low volume</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=2" title="Edit section: Low volume"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main articles: <a href="/wiki/Hypovolemia" title="Hypovolemia">Hypovolemia</a> and <a href="/wiki/Hypovolemic_shock" title="Hypovolemic shock">Hypovolemic shock</a></div><p><a href="/wiki/Hypovolemic_shock" title="Hypovolemic shock">Hypovolemic shock</a> is the most common type of shock and is caused by insufficient circulating <a href="/wiki/Blood_volume" title="Blood volume">volume</a>.<sup id="cite_ref-Tint10_6-2" class="reference"><a href="#cite_note-Tint10-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> The most common cause of hypovolemic shock is <a href="/wiki/Haemorrhage" class="mw-redirect" title="Haemorrhage">hemorrhage</a> (internal or external); however, <a href="/wiki/Vomiting" title="Vomiting">vomiting</a> and <a href="/wiki/Diarrhea" title="Diarrhea">diarrhea</a> are more common causes in children.<sup id="cite_ref-EMB05_9-0" class="reference"><a href="#cite_note-EMB05-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Other causes include burns, as well as excess urine loss due to <a href="/wiki/Diabetic_ketoacidosis" title="Diabetic ketoacidosis">diabetic ketoacidosis</a> and <a href="/wiki/Diabetes_insipidus" title="Diabetes insipidus">diabetes insipidus</a>.<sup id="cite_ref-EMB05_9-1" class="reference"><a href="#cite_note-EMB05-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><table class="wikitable" style="float: right; margin-left:15px; text-align:center"> <caption>Hemorrhage classes<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </caption> <tbody><tr> <th>Class</th> <th>Blood loss (liters)</th> <th>Response</th> <th>Treatment </th></tr> <tr> <td>I</td> <td><15% (0.75 L)</td> <td>min. fast heart rate, normal blood pressure</td> <td>minimal </td></tr> <tr> <td>II</td> <td>15–30% (0.75–1.5 L)</td> <td>fast heart rate, min. low blood pressure</td> <td>intravenous fluids </td></tr> <tr> <td>III</td> <td>30–40% (1.5–2 L)</td> <td>very fast heart rate, low blood pressure, confusion</td> <td>fluids and packed RBCs </td></tr> <tr> <td>IV</td> <td>>40% (>2 L)</td> <td>critical blood pressure and heart rate</td> <td>aggressive interventions </td></tr></tbody></table> <p>Signs and symptoms of hypovolemic shock include: </p> <ul><li>A rapid, weak, thready pulse due to decreased blood flow combined with <a href="/wiki/Tachycardia" title="Tachycardia">tachycardia</a><sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li>Cool skin due to <a href="/wiki/Vasoconstriction" title="Vasoconstriction">vasoconstriction</a> and stimulation of vasoconstriction<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li>Rapid and <a href="/wiki/Shallow_breathing" title="Shallow breathing">shallow breathing</a> due to <a href="/wiki/Sympathetic_nervous_system" title="Sympathetic nervous system">sympathetic nervous system</a> stimulation and <a href="/wiki/Acidosis" title="Acidosis">acidosis</a><sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li><a href="/wiki/Hypothermia" title="Hypothermia">Hypothermia</a> due to decreased <a href="/wiki/Perfusion" title="Perfusion">perfusion</a> and evaporation of sweat<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li>Thirst and dry mouth, due to fluid depletion<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li>Cold and mottled skin (<a href="/wiki/Livedo_reticularis" title="Livedo reticularis">livedo reticularis</a>), especially extremities, due to insufficient perfusion of the skin<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li></ul> <p>The severity of hemorrhagic shock can be graded on a 1–4 scale on the physical signs. The <a href="/wiki/Shock_index" class="mw-redirect" title="Shock index">shock index</a> (heart rate divided by systolic blood pressure) is a stronger predictor of the impact of blood loss than heart rate and blood pressure alone.<sup id="cite_ref-Olaussen_11-0" class="reference"><a href="#cite_note-Olaussen-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> This relationship has not been well established in pregnancy-related bleeding.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Cardiogenic">Cardiogenic</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=3" title="Edit section: Cardiogenic"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Cardiogenic_shock" title="Cardiogenic shock">Cardiogenic shock</a></div> <p><a href="/wiki/Cardiogenic_shock" title="Cardiogenic shock">Cardiogenic shock</a> is caused by the failure of the heart to pump effectively.<sup id="cite_ref-Tint10_6-3" class="reference"><a href="#cite_note-Tint10-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> This can be due to damage to the heart muscle, most often from a large <a href="/wiki/Myocardial_infarction" title="Myocardial infarction">myocardial infarction</a>. Other causes of cardiogenic shock include <a href="/wiki/Cardiac_dysrhythmia" class="mw-redirect" title="Cardiac dysrhythmia">dysrhythmias</a>, <a href="/wiki/Cardiomyopathy" title="Cardiomyopathy">cardiomyopathy</a>/<a href="/wiki/Myocarditis" title="Myocarditis">myocarditis</a>, <a href="/wiki/Congestive_heart_failure" class="mw-redirect" title="Congestive heart failure">congestive heart failure</a> (CHF), <a href="/wiki/Myocardial_contusion" class="mw-redirect" title="Myocardial contusion">myocardial contusion</a>, or <a href="/wiki/Valvular_heart_disease" title="Valvular heart disease">valvular heart disease</a> problems.<sup id="cite_ref-EMB05_9-2" class="reference"><a href="#cite_note-EMB05-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><p>Symptoms of <a href="/wiki/Cardiogenic_shock" title="Cardiogenic shock">cardiogenic shock</a> include: </p> <ul><li>Distended <a href="/wiki/Jugular_vein" title="Jugular vein">jugular veins</a> due to increased <a href="/wiki/Jugular_venous_pressure" title="Jugular venous pressure">jugular venous pressure</a><sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li>Weak or absent pulse<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li><a href="/wiki/Heart_arrhythmia" class="mw-redirect" title="Heart arrhythmia">Abnormal heart rhythms</a>, often a <a href="/wiki/Tachycardia" title="Tachycardia">fast heart rate</a><sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li><a href="/wiki/Pulsus_paradoxus" title="Pulsus paradoxus">Pulsus paradoxus</a> in case of <a href="/wiki/Cardiac_tamponade" title="Cardiac tamponade">tamponade</a></li> <li><a href="/wiki/Hypotension" title="Hypotension">Reduced blood pressure</a></li> <li><a href="/wiki/Shortness_of_breath" title="Shortness of breath">Shortness of breath</a>, due to <a href="/wiki/Pulmonary_congestion" class="mw-redirect" title="Pulmonary congestion">pulmonary congestion</a></li></ul> <div class="mw-heading mw-heading3"><h3 id="Obstructive">Obstructive</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=4" title="Edit section: Obstructive"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Obstructive_shock" title="Obstructive shock">Obstructive shock</a></div> <p><a href="/wiki/Obstructive_shock" title="Obstructive shock">Obstructive shock</a> is a form of shock associated with physical obstruction of the <a href="/wiki/Great_vessels" title="Great vessels">great vessels</a> of the systemic or pulmonary circulation.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Several conditions can result in this form of shock. </p> <ul><li><a href="/wiki/Cardiac_tamponade" title="Cardiac tamponade">Cardiac tamponade</a>, in which fluid in the <a href="/wiki/Pericardium" title="Pericardium">pericardium</a> prevents inflow of blood into the heart (<a href="/wiki/Venous_return" title="Venous return">venous return</a>).<sup id="cite_ref-EMB05_9-3" class="reference"><a href="#cite_note-EMB05-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Constrictive_pericarditis" title="Constrictive pericarditis">Constrictive pericarditis</a>, in which the <a href="/wiki/Pericardium" title="Pericardium">pericardium</a> shrinks and hardens, is similar in presentation.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li><a href="/wiki/Tension_pneumothorax" class="mw-redirect" title="Tension pneumothorax">Tension pneumothorax</a>; Through increased intrathoracic pressure, venous return is impeded.<sup id="cite_ref-EMB05_9-4" class="reference"><a href="#cite_note-EMB05-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Pulmonary_embolism" title="Pulmonary embolism">Pulmonary embolism</a> is thromboembolism of the <a href="/wiki/Lung" title="Lung">lungs</a>, hindering oxygenation and return of blood to the heart.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li><a href="/wiki/Aortic_stenosis" title="Aortic stenosis">Aortic stenosis</a> hinders circulation by obstructing the <a href="/wiki/Cardiac_output" title="Cardiac output">cardiac output</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li><a href="/wiki/Hypertrophic_sub-aortic_stenosis" class="mw-redirect" title="Hypertrophic sub-aortic stenosis">Hypertrophic sub-aortic stenosis</a> is overly thick ventricular muscle that dynamically occludes the <a href="/wiki/Ventricular_outflow_tract" title="Ventricular outflow tract">ventricular outflow tract</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li><a href="/wiki/Abdominal_compartment_syndrome" title="Abdominal compartment syndrome">Abdominal compartment syndrome</a> defined as an increase in intra-abdominal pressure to > 20 mmHg with organ dysfunction.<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> Increased intra-abdominal pressure can result from <a href="/wiki/Sepsis" title="Sepsis">sepsis</a> and severe abdominal trauma. This increased pressure reduces venous return, thereby reducing lung-heart function, resulting in signs and symptoms of shock.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup></li></ul> <p>Many of the signs of obstructive shock are similar to cardiogenic shock, although treatments differ. Symptoms of obstructive shock include: </p> <ul><li><a href="/wiki/Heart_arrhythmia" class="mw-redirect" title="Heart arrhythmia">Abnormal heart rhythms</a>, often a <a href="/wiki/Tachycardia" title="Tachycardia">fast heart rate</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li>Reduced blood pressure.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li>Cool, clammy, mottled skin, often due to low blood pressure and vasoconstriction.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li><a href="/wiki/Oliguria" title="Oliguria">Decreased urine output</a>.</li></ul> <div class="mw-heading mw-heading3"><h3 id="Distributive">Distributive</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=5" title="Edit section: Distributive"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Distributive_shock" title="Distributive shock">Distributive shock</a></div> <table class="wikitable" style="float: right; margin-left:15px; text-align:center"> <caption><a href="/wiki/Systemic_inflammatory_response_syndrome" title="Systemic inflammatory response syndrome">Systemic inflammatory response syndrome</a><sup id="cite_ref-pmid1303622_16-0" class="reference"><a href="#cite_note-pmid1303622-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </caption> <tbody><tr> <th>Finding</th> <th>Value </th></tr> <tr> <td><a href="/wiki/Normal_human_body_temperature" class="mw-redirect" title="Normal human body temperature">Temperature</a></td> <td><36 °C (96.8 °F) or >38 °C (100.4 °F) </td></tr> <tr> <td><a href="/wiki/Heart_rate" title="Heart rate">Heart rate</a></td> <td>>90/min </td></tr> <tr> <td><a href="/wiki/Respiratory_rate" title="Respiratory rate">Respiratory rate</a></td> <td>>20/min or <a href="/wiki/Arterial_blood_gas" class="mw-redirect" title="Arterial blood gas">PaCO2</a><32 mmHg (4.3 kPa) </td></tr> <tr> <td><a href="/wiki/White_blood_cell_count" class="mw-redirect" title="White blood cell count">WBC</a></td> <td><4x10<sup>9</sup>/L (<4000/mm<sup>3</sup>), >12x10<sup>9</sup>/L (>12,000/mm<sup>3</sup>), or ≥10% <a href="/wiki/Immature_neutrophil" class="mw-redirect" title="Immature neutrophil">bands</a> </td></tr></tbody></table> <p><a href="/wiki/Distributive_shock" title="Distributive shock">Distributive shock</a> is low blood pressure due to a <a href="/wiki/Vasodilation" title="Vasodilation">dilation of blood vessels</a> within the body.<sup id="cite_ref-Tint10_6-4" class="reference"><a href="#cite_note-Tint10-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:0_17-0" class="reference"><a href="#cite_note-:0-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> This can be caused by systemic infection (<a href="/wiki/Sepsis" title="Sepsis">septic shock</a>), a severe allergic reaction (<a href="/wiki/Anaphylaxis" title="Anaphylaxis">anaphylaxis</a>), or spinal cord injury (<a href="/wiki/Neurogenic_shock" title="Neurogenic shock">neurogenic shock</a>).<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"></p><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Septic_shock" title="Septic shock">Septic shock</a></div> <ul><li><a href="/wiki/Septic_shock" title="Septic shock">Septic shock</a> is the most common cause of distributive shock.<sup id="cite_ref-EMB05_9-5" class="reference"><a href="#cite_note-EMB05-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> It is caused by an overwhelming systemic infection resulting in <a href="/wiki/Vasodilation" title="Vasodilation">vasodilation</a> leading to hypotension. Septic shock can be caused by <a href="/wiki/Gram_negative" class="mw-redirect" title="Gram negative">Gram negative</a> bacteria such as (among others) <i><a href="/wiki/Escherichia_coli" title="Escherichia coli">Escherichia coli</a></i>, <a href="/wiki/Proteus_(bacterium)" title="Proteus (bacterium)">Proteus</a> species, <i><a href="/wiki/Klebsiella_pneumoniae" title="Klebsiella pneumoniae">Klebsiella pneumoniae</a></i> (which have an <a href="/wiki/Endotoxin" class="mw-redirect" title="Endotoxin">endotoxin</a> on their surface that produces adverse biochemical, immunological and occasionally neurological effects which are harmful to the body), other <a href="/wiki/Gram-positive" class="mw-redirect" title="Gram-positive">Gram-positive</a> cocci, such as <a href="/wiki/Pneumococci" class="mw-redirect" title="Pneumococci">pneumococci</a> and <a href="/wiki/Streptococci" class="mw-redirect" title="Streptococci">streptococci</a>, and certain fungi as well as Gram-positive <a href="/wiki/Microbial_toxin" title="Microbial toxin">bacterial toxins</a>. Septic shock also includes some elements of cardiogenic shock. In 1992, the <a href="/wiki/American_College_of_Chest_Physicians" title="American College of Chest Physicians">ACCP</a>/<a href="/wiki/Society_of_Critical_Care_Medicine" title="Society of Critical Care Medicine">SCCM</a> Consensus Conference Committee defined septic shock: " ... sepsis-induced hypotension (systolic blood pressure < 90 mmHg or a reduction of 40 mmHg from baseline) despite adequate fluid resuscitation along with the presence of perfusion abnormalities that may include, but are not limited to: <a href="/wiki/Lactic_acidosis" title="Lactic acidosis">lactic acidosis</a>, oliguria, or an acute alteration in mental status. Patients who are receiving <a href="/wiki/Inotrope" title="Inotrope">inotropic</a> or vasopressor agents may have a normalized blood pressure at the time that perfusion abnormalities are identified. The pathophysiology behind septic shock is as follows: 1) Systemic <a href="/wiki/Leukocyte" class="mw-redirect" title="Leukocyte">leukocyte</a> adhesion to endothelial cells<sup id="cite_ref-Robbins_18-0" class="reference"><a href="#cite_note-Robbins-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> 2) Reduced <a href="/wiki/Myocardial_contractility" title="Myocardial contractility">contractility of the heart</a><sup id="cite_ref-Robbins_18-1" class="reference"><a href="#cite_note-Robbins-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> 3) Activation of the <a href="/wiki/Coagulation_pathway" class="mw-redirect" title="Coagulation pathway">coagulation pathways</a>, resulting in <a href="/wiki/Disseminated_intravascular_coagulation" title="Disseminated intravascular coagulation">disseminated intravascular coagulation</a><sup id="cite_ref-Robbins_18-2" class="reference"><a href="#cite_note-Robbins-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> 4). Increased levels of <a href="/wiki/Neutrophils" class="mw-redirect" title="Neutrophils">neutrophils</a><sup id="cite_ref-Robbins_18-3" class="reference"><a href="#cite_note-Robbins-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> <ul><li>The main manifestations of septic shock are due to the massive release of <a href="/wiki/Histamine" title="Histamine">histamine</a> which causes intense dilation of the blood vessels. People with septic shock will also likely be positive for <a href="/wiki/Systemic_inflammatory_response_syndrome" title="Systemic inflammatory response syndrome">SIRS</a> criteria. The most generally accepted treatment for these patients is early recognition of symptoms, and early administration of broad spectrum and organism specific antibiotics.<sup id="cite_ref-survsep_19-0" class="reference"><a href="#cite_note-survsep-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup></li> <li>Signs of septic shock include:<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup> <ul><li><a href="/wiki/Heart_arrhythmia" class="mw-redirect" title="Heart arrhythmia">Abnormal heart rhythms</a>, often a <a href="/wiki/Tachycardia" title="Tachycardia">fast heart rate</a></li> <li>Reduced blood pressure</li> <li><a href="/wiki/Oliguria" title="Oliguria">Decreased urine output</a></li> <li><a href="/wiki/Altered_level_of_consciousness" title="Altered level of consciousness">Altered mental status</a></li></ul></li></ul></li> <li><a href="/wiki/Anaphylactic_shock" class="mw-redirect" title="Anaphylactic shock">Anaphylactic shock</a> is caused by a severe <a href="/wiki/Anaphylaxis" title="Anaphylaxis">anaphylactic reaction</a> to an <a href="/wiki/Allergen" title="Allergen">allergen</a>, <a href="/wiki/Antigen" title="Antigen">antigen</a>, <a href="/wiki/Drug" title="Drug">drug</a>, or foreign protein causing the release of <a href="/wiki/Histamine" title="Histamine">histamine</a> which causes widespread vasodilation, leading to hypotension and increased <a href="/wiki/Capillary_permeability" class="mw-redirect" title="Capillary permeability">capillary permeability</a>. <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Signs_and_symptoms_of_anaphylaxis.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/8/8f/Signs_and_symptoms_of_anaphylaxis.svg/220px-Signs_and_symptoms_of_anaphylaxis.svg.png" decoding="async" width="220" height="185" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/8f/Signs_and_symptoms_of_anaphylaxis.svg/330px-Signs_and_symptoms_of_anaphylaxis.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/8f/Signs_and_symptoms_of_anaphylaxis.svg/440px-Signs_and_symptoms_of_anaphylaxis.svg.png 2x" data-file-width="1467" data-file-height="1234" /></a><figcaption>Signs of anaphylaxis</figcaption></figure>Signs typically occur after exposure to an allergen and may include: <ul><li>Skin changes, such as <a href="/wiki/Hives" title="Hives">hives</a>, itching, flushing, and swelling.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li>Wheezing and <a href="/wiki/Shortness_of_breath" title="Shortness of breath">shortness of breath</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li><a href="/wiki/Abdominal_pain" title="Abdominal pain">Abdominal pain</a>, <a href="/wiki/Diarrhea" title="Diarrhea">diarrhea</a>, and <a href="/wiki/Vomiting" title="Vomiting">vomiting</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li>Lightheadedness, <a href="/wiki/Altered_state_of_consciousness" title="Altered state of consciousness">confusion</a>, <a href="/wiki/Headache" title="Headache">headaches</a>, <a href="/wiki/Loss_of_consciousness" class="mw-redirect" title="Loss of consciousness">loss of consciousness</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li></ul></li> <li>High spinal injuries may cause <a href="/wiki/Neurogenic_shock" title="Neurogenic shock">neurogenic shock</a>, which is commonly classified as a subset of distributive shock.<sup id="cite_ref-Trauma07_20-0" class="reference"><a href="#cite_note-Trauma07-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> The classic symptoms include <a href="/wiki/Bradycardia" title="Bradycardia">a slow heart rate</a> due to loss of cardiac <a href="/wiki/Sympathetic_nervous_system" title="Sympathetic nervous system">sympathetic tone</a> and warm skin due to dilation of the peripheral blood vessels.<sup id="cite_ref-Trauma07_20-1" class="reference"><a href="#cite_note-Trauma07-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> (This term can be confused with <a href="/wiki/Spinal_shock" title="Spinal shock">spinal shock</a> which is a recoverable loss of function of the <a href="/wiki/Spinal_cord" title="Spinal cord">spinal cord</a> after injury and does not refer to the hemodynamic instability.)</li></ul> <div class="mw-heading mw-heading4"><h4 id="Endocrine">Endocrine</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=6" title="Edit section: Endocrine"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Although not officially classified as a subcategory of shock, many <a href="/wiki/Endocrinological" class="mw-redirect" title="Endocrinological">endocrinological</a> disturbances in their severe form can result in shock.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (September 2022)">citation needed</span></a></i>]</sup> </p> <ul><li><a href="/wiki/Hypothyroidism" title="Hypothyroidism">Hypothyroidism</a> (can be considered a form of <a href="/wiki/Cardiogenic_shock" title="Cardiogenic shock">cardiogenic shock</a>) in people who are critically ill patients reduces <a href="/wiki/Cardiac_output" title="Cardiac output">cardiac output</a> and can lead to <a href="/wiki/Hypotension" title="Hypotension">hypotension</a> and respiratory insufficiency.</li> <li><a href="/wiki/Hyperthyroidism" title="Hyperthyroidism">Thyrotoxicosis</a> (<a href="/wiki/Cardiogenic_shock" title="Cardiogenic shock">cardiogenic shock</a>) may induce a reversible <a href="/wiki/Cardiomyopathy" title="Cardiomyopathy">cardiomyopathy</a>.</li> <li>Acute <a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">adrenal insufficiency</a> (<a href="/wiki/Distributive_shock" title="Distributive shock">distributive shock</a>) is frequently the result of discontinuing <a href="/wiki/Corticosteroid" title="Corticosteroid">corticosteroid</a> treatment without tapering the dosage. However, surgery and intercurrent disease in patients on corticosteroid therapy without adjusting the dosage to accommodate for increased requirements may also result in this condition.</li> <li>Relative <a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">adrenal insufficiency</a> (<a href="/wiki/Distributive_shock" title="Distributive shock">distributive shock</a>) in critically ill patients where present <a href="/wiki/Cortisol" title="Cortisol">hormone levels</a> are insufficient to meet the higher demands.</li></ul> <div class="mw-heading mw-heading2"><h2 id="Cause">Cause</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=7" title="Edit section: Cause"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <table class="wikitable" style="float: right; margin-left:15px; text-align:center"> <tbody><tr> <th>Type </th> <th>Cause </th></tr> <tr> <td>Low volume </td> <td>Fluid loss such as bleeding or diarrhea </td></tr> <tr> <td>Cardiogenic </td> <td>Ineffective pumping due to heart damage </td></tr> <tr> <td>Obstructive </td> <td>Blood flow to or from the heart is blocked </td></tr> <tr> <td>Distributive </td> <td>Abnormal flow within the small blood vessels<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </td></tr></tbody></table> <p>Shock is a common end point of many medical conditions.<sup id="cite_ref-EMB05_9-6" class="reference"><a href="#cite_note-EMB05-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Shock triggered by a serious <a href="/wiki/Allergic_reaction" class="mw-redirect" title="Allergic reaction">allergic reaction</a> is known as <a href="/wiki/Anaphylactic_shock" class="mw-redirect" title="Anaphylactic shock">anaphylactic shock</a>, shock triggered by severe <a href="/wiki/Dehydration" title="Dehydration">dehydration</a> or <a href="/wiki/Blood_loss" class="mw-redirect" title="Blood loss">blood loss</a> is known as <a href="/wiki/Hypovolemic_shock" title="Hypovolemic shock">hypovolemic shock</a>, shock caused by sepsis is known as <a href="/wiki/Septic_shock" title="Septic shock">septic shock</a>, etc. Shock itself is a life-threatening condition as a result of compromised <a href="/wiki/Circulatory_system" title="Circulatory system">body circulation</a>.<sup id="cite_ref-UpToDate_2019_22-0" class="reference"><a href="#cite_note-UpToDate_2019-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> It can be divided into four main types based on the underlying cause: hypovolemic, distributive, cardiogenic, and obstructive.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> A few additional classifications are occasionally used, such as endocrinologic shock.<sup id="cite_ref-EMB05_9-7" class="reference"><a href="#cite_note-EMB05-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=8" title="Edit section: Pathophysiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure typeof="mw:File/Thumb"><a href="/wiki/File:Shock-cell2.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Shock-cell2.svg/500px-Shock-cell2.svg.png" decoding="async" width="500" height="340" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Shock-cell2.svg/750px-Shock-cell2.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Shock-cell2.svg/1000px-Shock-cell2.svg.png 2x" data-file-width="814" data-file-height="554" /></a><figcaption>Effects of inadequate perfusion on cell function</figcaption></figure> <p>Shock is a complex and continuous condition, and there is no sudden transition from one stage to the next.<sup id="cite_ref-Armstrong_24-0" class="reference"><a href="#cite_note-Armstrong-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> At a cellular level, shock is the process of oxygen demand becoming greater than oxygen supply.<sup id="cite_ref-Tint10_6-5" class="reference"><a href="#cite_note-Tint10-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>One of the key dangers of shock is that it progresses by a <a href="/wiki/Positive_feedback" title="Positive feedback">positive feedback</a> loop. Poor blood supply leads to cellular damage, which results in an inflammatory response to increase blood flow to the affected area. Normally, this causes the blood supply level to match with tissue demand for nutrients. However, if there is enough increased demand in some areas, it can deprive other areas of sufficient supply, which then start demanding more. This then leads to an ever escalating cascade.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup> </p><p>As such, shock is a <a href="/wiki/Chain_reaction" title="Chain reaction">runaway</a> condition of <a href="/wiki/Homeostasis" title="Homeostasis">homeostatic</a> failure, where the usual corrective mechanisms relating to oxygenation of the body no longer function in a stable way. When it occurs, immediate treatment is critical in order to return an individual's metabolism into a stable, self-correcting trajectory. Otherwise the condition can become increasingly difficult to correct, surprisingly quickly, and then progress to a fatal outcome. In the particular case of anaphylactic shock, progression to death might take just a few minutes.<sup id="cite_ref-Guyton_25-0" class="reference"><a href="#cite_note-Guyton-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Initial">Initial</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=9" title="Edit section: Initial"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>During the Initial stage (Stage 1), the state of <a href="/wiki/Hypoperfusion" class="mw-redirect" title="Hypoperfusion">hypoperfusion</a> causes <a href="/wiki/Hypoxia_(medical)" class="mw-redirect" title="Hypoxia (medical)">hypoxia</a>. Due to the lack of oxygen, the cells perform <a href="/wiki/Lactic_acid_fermentation" title="Lactic acid fermentation">lactic acid fermentation</a>. Since oxygen, the terminal electron acceptor in the <a href="/wiki/Electron_transport_chain" title="Electron transport chain">electron transport chain</a>, is not abundant, this slows down entry of <a href="/wiki/Pyruvate" class="mw-redirect" title="Pyruvate">pyruvate</a> into the <a href="/wiki/Citric_acid_cycle" title="Citric acid cycle">Krebs cycle</a>, resulting in its accumulation. The accumulating pyruvate is converted to <a href="/wiki/Lactic_acid" title="Lactic acid">lactate (lactic acid)</a> by <a href="/wiki/Lactate_dehydrogenase" title="Lactate dehydrogenase">lactate dehydrogenase</a>. The accumulating lactate causes <a href="/wiki/Lactic_acidosis" title="Lactic acidosis">lactic acidosis</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Compensatory">Compensatory</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=10" title="Edit section: Compensatory"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The Compensatory stage (Stage 2) is characterised by the body employing physiological mechanisms, including neural, hormonal, and bio-chemical mechanisms, in an attempt to reverse the condition. As a result of the <a href="/wiki/Acidosis" title="Acidosis">acidosis</a>, the person will begin to <a href="/wiki/Hyperventilation" title="Hyperventilation">hyperventilate</a> in order to rid the body of carbon dioxide (CO<sub>2</sub>) since it indirectly acts to acidify the blood; the body attempts to return to <a href="/wiki/Acid%E2%80%93base_homeostasis" title="Acid–base homeostasis">acid–base homeostasis</a> by removing that acidifying agent. The <a href="/wiki/Baroreceptors" class="mw-redirect" title="Baroreceptors">baroreceptors</a> in the <a href="/wiki/Artery" title="Artery">arteries</a> detect the <a href="/wiki/Hypotension" title="Hypotension">hypotension</a> resulting from large amounts of blood being redirected to distant tissues, and cause the release of <a href="/wiki/Epinephrine" class="mw-redirect" title="Epinephrine">epinephrine</a> and <a href="/wiki/Norepinephrine" title="Norepinephrine">norepinephrine</a>. Norepinephrine causes predominately <a href="/wiki/Vasoconstriction" title="Vasoconstriction">vasoconstriction</a> with a mild increase in <a href="/wiki/Heart_rate" title="Heart rate">heart rate</a>, whereas <a href="/wiki/Epinephrine" class="mw-redirect" title="Epinephrine">epinephrine</a> predominately causes an increase in <a href="/wiki/Heart_rate" title="Heart rate">heart rate</a> with a small effect on the <a href="/wiki/Blood_vessel" title="Blood vessel">vascular</a> tone; the combined effect results in an increase in <a href="/wiki/Blood_pressure" title="Blood pressure">blood pressure</a>. The <a href="/wiki/Renin%E2%80%93angiotensin_system" title="Renin–angiotensin system">renin–angiotensin axis</a> is activated, and <a href="/wiki/Arginine_vasopressin" class="mw-redirect" title="Arginine vasopressin">arginine vasopressin</a> (anti-diuretic hormone) is released to conserve fluid by reducing its excretion via the <a href="/wiki/Renal" class="mw-redirect" title="Renal">renal</a> system. These hormones cause the vasoconstriction of the <a href="/wiki/Kidney" title="Kidney">kidneys</a>, <a href="/wiki/Gastrointestinal_tract" title="Gastrointestinal tract">gastrointestinal tract</a>, and other organs to divert blood to the heart, <a href="/wiki/Lungs" class="mw-redirect" title="Lungs">lungs</a> and <a href="/wiki/Brain" title="Brain">brain</a>. The lack of blood to the renal system causes the characteristic low <a href="/wiki/Urine" title="Urine">urine</a> production. However, the effects of the renin–angiotensin axis take time and are of little importance to the immediate <a href="/wiki/Homeostatic" class="mw-redirect" title="Homeostatic">homeostatic</a> mediation of shock.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (June 2011)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Progressive/decompensated"><span id="Progressive.2Fdecompensated"></span>Progressive/decompensated</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=11" title="Edit section: Progressive/decompensated"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The Progressive stage (stage 3) results if the underlying cause of the shock is not successfully treated. During this stage, compensatory mechanisms begin to fail. Due to the decreased perfusion of the cells in the body, <a href="/wiki/Sodium" title="Sodium">sodium</a> ions build up within the intracellular space while <a href="/wiki/Potassium" title="Potassium">potassium</a> ions leak out. Due to lack of oxygen, <a href="/wiki/Cellular_respiration" title="Cellular respiration">cellular respiration</a> diminishes and <a href="/wiki/Anaerobic_respiration" title="Anaerobic respiration">anaerobic metabolism</a> predominates. As anaerobic metabolism continues, the arteriolar smooth muscle and precapillary <a href="/wiki/Sphincters" class="mw-redirect" title="Sphincters">sphincters</a> relax such that blood remains in the <a href="/wiki/Capillaries" class="mw-redirect" title="Capillaries">capillaries</a>.<sup id="cite_ref-Robbins_18-4" class="reference"><a href="#cite_note-Robbins-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> Due to this, the <a href="/wiki/Hydrostatics#Medicine" title="Hydrostatics">hydrostatic pressure</a> will increase and, combined with <a href="/wiki/Histamine" title="Histamine">histamine</a> release, will lead to <a href="/wiki/Extravasation" title="Extravasation">leakage of fluid</a> and <a href="/wiki/Protein" title="Protein">protein</a> into the surrounding tissues. As this fluid is lost, the blood concentration and <a href="/wiki/Viscosity" title="Viscosity">viscosity</a> increase, causing sludging of the micro-circulation. The prolonged vasoconstriction will also cause the vital organs to be compromised due to <a href="/wiki/Ischemia" title="Ischemia">reduced perfusion</a>.<sup id="cite_ref-Robbins_18-5" class="reference"><a href="#cite_note-Robbins-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> If the bowel becomes sufficiently <a href="/wiki/Ischemic" class="mw-redirect" title="Ischemic">ischemic</a>, bacteria may enter the blood stream, resulting in the increased complication of <a href="/wiki/Septic_shock" title="Septic shock">endotoxic shock</a>.<sup id="cite_ref-Guyton_25-1" class="reference"><a href="#cite_note-Guyton-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Robbins_18-6" class="reference"><a href="#cite_note-Robbins-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Refractory">Refractory</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=12" title="Edit section: Refractory"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>At Refractory stage (stage 4), the vital <a href="/wiki/Organ_failure" class="mw-redirect" title="Organ failure">organs have failed</a> and the shock can no longer be reversed. <a href="/wiki/Brain_damage" class="mw-redirect" title="Brain damage">Brain damage</a> and cell death are occurring, and death will occur imminently. One of the primary reasons that shock is irreversible at this point is that much of the cellular <a href="/wiki/Adenosine_triphosphate" title="Adenosine triphosphate">ATP</a> (the basic energy source for cells) has been degraded into <a href="/wiki/Adenosine" title="Adenosine">adenosine</a> in the absence of oxygen as an electron receptor in the <a href="/wiki/Mitochondrial_matrix" title="Mitochondrial matrix">mitochondrial matrix</a>. Adenosine easily perfuses out of cellular membranes into extracellular fluid, furthering capillary <a href="/wiki/Vasodilation" title="Vasodilation">vasodilation</a>, and then is transformed into <a href="/wiki/Uric_acid" title="Uric acid">uric acid</a>. Because cells can only produce adenosine at a rate of about 2% of the cell's total need per hour, even restoring oxygen is futile at this point because there is no adenosine to <a href="/wiki/Phosphorylate" class="mw-redirect" title="Phosphorylate">phosphorylate</a> into ATP.<sup id="cite_ref-Guyton_25-2" class="reference"><a href="#cite_note-Guyton-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=13" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The diagnosis of shock is commonly based on a combination of symptoms, <a href="/wiki/Physical_examination" title="Physical examination">physical examination</a>, and laboratory tests. Many signs and symptoms are not sensitive or specific for shock, thus many clinical decision-making tools have been developed to identify shock at an early stage.<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> A high degree of suspicion is necessary for the proper diagnosis of shock.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup> </p><p>Shock is, <a href="/wiki/Hemodynamic" class="mw-redirect" title="Hemodynamic">hemodynamically</a> speaking, inadequate blood flow or <a href="/wiki/Cardiac_output" title="Cardiac output">cardiac output</a>, Unfortunately, the measurement of cardiac output requires an invasive catheter, such as a pulmonary artery catheter. <a href="/wiki/Mixed_venous_oxygen_saturation" class="mw-redirect" title="Mixed venous oxygen saturation">Mixed venous oxygen saturation</a> (SmvO2) is one of the methods of calculating cardiac output with a pulmonary artery catheter. <a href="/wiki/Central_venous_oxygen_saturation" class="mw-redirect" title="Central venous oxygen saturation">Central venous oxygen saturation</a> (ScvO2) as measured via a central line correlates well with SmvO2 and is easier to acquire. Tissue <a href="https://en.wiktionary.org/wiki/oxygenate" class="extiw" title="wikt:oxygenate">oxygenation</a> is critically dependent on blood flow. When the oxygenation of tissues is compromised <a href="/wiki/Anaerobic_metabolism" class="mw-redirect" title="Anaerobic metabolism">anaerobic metabolism</a> will begin and lactic acid will be produced. <sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Management">Management</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=14" title="Edit section: Management"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Treatment of shock is based on the likely underlying cause.<sup id="cite_ref-ATLS2018_2-6" class="reference"><a href="#cite_note-ATLS2018-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> An open <a href="/wiki/Airway" class="mw-redirect" title="Airway">airway</a> and sufficient <a href="/wiki/Breathing" title="Breathing">breathing</a> should be established.<sup id="cite_ref-ATLS2018_2-7" class="reference"><a href="#cite_note-ATLS2018-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Any ongoing bleeding should be stopped, which may require surgery or <a href="/wiki/Embolization" title="Embolization">embolization</a>.<sup id="cite_ref-ATLS2018_2-8" class="reference"><a href="#cite_note-ATLS2018-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Intravenous_fluid" class="mw-redirect" title="Intravenous fluid">Intravenous fluid</a>, such as <a href="/wiki/Ringer%27s_lactate" class="mw-redirect" title="Ringer's lactate">Ringer's lactate</a> or <a href="/wiki/Packed_red_blood_cells" title="Packed red blood cells">packed red blood cells</a>, is often given.<sup id="cite_ref-ATLS2018_2-9" class="reference"><a href="#cite_note-ATLS2018-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Efforts to maintain a normal <a href="/wiki/Body_temperature" class="mw-redirect" title="Body temperature">body temperature</a> are also important.<sup id="cite_ref-ATLS2018_2-10" class="reference"><a href="#cite_note-ATLS2018-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Vasopressors" class="mw-redirect" title="Vasopressors">Vasopressors</a> may be useful in certain cases.<sup id="cite_ref-ATLS2018_2-11" class="reference"><a href="#cite_note-ATLS2018-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Shock is both common and has a high risk of death.<sup id="cite_ref-Tab2010_3-2" class="reference"><a href="#cite_note-Tab2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> In the United States about 1.2 million people present to the emergency room each year with shock and their risk of death is between 20 and 50%.<sup id="cite_ref-Tab2010_3-3" class="reference"><a href="#cite_note-Tab2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><p>The best evidence exists for the treatment of <a href="/wiki/Septic_shock" title="Septic shock">septic shock</a> in adults. However, the pathophysiology of shock in children appears to be similar so treatment methodologies have been extrapolated to children.<sup id="cite_ref-EMB05_9-8" class="reference"><a href="#cite_note-EMB05-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Management may include securing the airway via <a href="/wiki/Intubation" title="Intubation">intubation</a> if necessary to decrease the work of breathing and for guarding against respiratory arrest. <a href="/wiki/Oxygen_therapy" title="Oxygen therapy">Oxygen supplementation</a>, <a href="/wiki/Intravenous_therapy" title="Intravenous therapy">intravenous fluids</a>, <a href="/wiki/Passive_leg_raising_test" class="mw-redirect" title="Passive leg raising test">passive leg raising</a> (not <a href="/wiki/Trendelenburg_position" title="Trendelenburg position">Trendelenburg position</a>) should be started and <a href="/wiki/Blood_transfusion" title="Blood transfusion">blood transfusions</a> added if blood loss is severe.<sup id="cite_ref-Tint10_6-6" class="reference"><a href="#cite_note-Tint10-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> In select cases, compression devices like <a href="/wiki/Non-pneumatic_anti-shock_garment" title="Non-pneumatic anti-shock garment">non-pneumatic anti-shock garments</a> (or the deprecated <a href="/wiki/Military_anti-shock_trousers" title="Military anti-shock trousers">military anti-shock trousers</a>) can be used to prevent further blood loss and concentrate fluid in the body's head and core.<sup id="cite_ref-non-pneumo_pants_28-0" class="reference"><a href="#cite_note-non-pneumo_pants-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> It is important to keep the person warm to avoid <a href="/wiki/Hypothermia" title="Hypothermia">hypothermia</a><sup id="cite_ref-Nolan_Pullinger_pp._bmj.g1139–bmj.g1139_29-0" class="reference"><a href="#cite_note-Nolan_Pullinger_pp._bmj.g1139–bmj.g1139-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> as well as adequately manage pain and anxiety as these can increase oxygen consumption.<sup id="cite_ref-Tint10_6-7" class="reference"><a href="#cite_note-Tint10-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Negative impact by shock is reversible if it's recognized and treated early in time.<sup id="cite_ref-UpToDate_2019_22-1" class="reference"><a href="#cite_note-UpToDate_2019-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Fluids">Fluids</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=15" title="Edit section: Fluids"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Aggressive intravenous fluids are recommended in most types of shock (e.g. 1–2 liter <a href="/wiki/Normal_saline" class="mw-redirect" title="Normal saline">normal saline</a> bolus over 10 minutes or 20 mL/kg in a child) which is usually instituted as the person is being further evaluated.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Colloids" class="mw-redirect" title="Colloids">Colloids</a> and <a href="/wiki/Crystalloid_fluid" class="mw-redirect" title="Crystalloid fluid">crystalloids</a> appear to be equally effective with respect to outcomes.,<sup id="cite_ref-Lew2018_31-0" class="reference"><a href="#cite_note-Lew2018-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> Balanced crystalloids and normal saline also appear to be equally effective in critically ill patients.<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> If the person remains in shock after initial resuscitation, <a href="/wiki/Packed_red_blood_cells" title="Packed red blood cells">packed red blood cells</a> should be administered to keep the <a href="/wiki/Hemoglobin" title="Hemoglobin">hemoglobin</a> greater than 100 g/L.<sup id="cite_ref-Tint10_6-8" class="reference"><a href="#cite_note-Tint10-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>For those with hemorrhagic shock, the current evidence supports limiting the use of fluids for penetrating thorax and abdominal injuries allowing mild <a href="/wiki/Hypotension" title="Hypotension">hypotension</a> to persist (known as <a href="/wiki/Permissive_hypotension" title="Permissive hypotension">permissive hypotension</a>).<sup id="cite_ref-Rosen2010_33-0" class="reference"><a href="#cite_note-Rosen2010-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> Targets include a <a href="/wiki/Mean_arterial_pressure" title="Mean arterial pressure">mean arterial pressure</a> of 60 mmHg, a <a href="/wiki/Systolic_blood_pressure" class="mw-redirect" title="Systolic blood pressure">systolic blood pressure</a> of 70–90 mmHg,<sup id="cite_ref-Tint10_6-9" class="reference"><a href="#cite_note-Tint10-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-EMB11_34-0" class="reference"><a href="#cite_note-EMB11-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> or until the patient has adequate <a href="/wiki/Mentation" class="mw-redirect" title="Mentation">mentation</a> and peripheral pulses.<sup id="cite_ref-EMB11_34-1" class="reference"><a href="#cite_note-EMB11-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Tonicity#Hypertonic_solution" title="Tonicity">Hypertonic fluid</a> may also be an option in this group.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Medications">Medications</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=16" title="Edit section: Medications"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Epipen.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/6/60/Epipen.jpg/220px-Epipen.jpg" decoding="async" width="220" height="53" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/6/60/Epipen.jpg/330px-Epipen.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/6/60/Epipen.jpg/440px-Epipen.jpg 2x" data-file-width="500" data-file-height="120" /></a><figcaption>Epinephrine auto-injector</figcaption></figure> <p><a href="/wiki/Vasopressors" class="mw-redirect" title="Vasopressors">Vasopressors</a> may be used if blood pressure does not improve with fluids. Common vasopressors used in shock include: <a href="/wiki/Norepinephrine_(medication)" title="Norepinephrine (medication)">norepinephrine</a>, <a href="/wiki/Phenylephrine" title="Phenylephrine">phenylephrine</a>, <a href="/wiki/Dopamine" title="Dopamine">dopamine</a>, and <a href="/wiki/Dobutamine" title="Dobutamine">dobutamine</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup> </p><p>There is no evidence of substantial benefit of one vasopressor over another;<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> however, using dopamine leads to an increased risk of arrhythmia when compared with norepinephrine.<sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> Vasopressors have not been found to improve outcomes when used for <a href="/wiki/Hemorrhagic_shock" class="mw-redirect" title="Hemorrhagic shock">hemorrhagic shock</a> from <a href="/wiki/Trauma_(medical)" class="mw-redirect" title="Trauma (medical)">trauma</a><sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> but may be of use in <a href="/wiki/Neurogenic_shock" title="Neurogenic shock">neurogenic shock</a>.<sup id="cite_ref-Trauma07_20-2" class="reference"><a href="#cite_note-Trauma07-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Activated_protein_C" class="mw-redirect" title="Activated protein C">Activated protein C</a> (Xigris), while once aggressively promoted for the management of <a href="/wiki/Septic_shock" title="Septic shock">septic shock</a>, has been found not to improve survival and is associated with a number of complications.<sup id="cite_ref-:marti-carvajal_39-0" class="reference"><a href="#cite_note-:marti-carvajal-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> Activated protein C was withdrawn from the market in 2011, and clinical trials were discontinued.<sup id="cite_ref-:marti-carvajal_39-1" class="reference"><a href="#cite_note-:marti-carvajal-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> The use of <a href="/wiki/Sodium_bicarbonate" title="Sodium bicarbonate">sodium bicarbonate</a> is controversial as it has not been shown to improve outcomes.<sup id="cite_ref-bicarb08_40-0" class="reference"><a href="#cite_note-bicarb08-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> If used at all it should only be considered if the blood pH is less than 7.0.<sup id="cite_ref-bicarb08_40-1" class="reference"><a href="#cite_note-bicarb08-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p><p>People with anaphylactic shock are commonly treated with <a href="/wiki/Epinephrine_autoinjector" title="Epinephrine autoinjector">epinephrine</a>. <a href="/wiki/Antihistamine" title="Antihistamine">Antihistamines</a>, such as <a href="/wiki/Benadryl" title="Benadryl">Benadryl</a> (<a href="/wiki/Diphenhydramine" title="Diphenhydramine">diphenhydramine</a>) or <a href="/wiki/Ranitidine" title="Ranitidine">ranitidine</a> are also commonly administered. <a href="/wiki/Albuterol" class="mw-redirect" title="Albuterol">Albuterol</a>, normal saline, and steroids are also commonly given.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Mechanical_support">Mechanical support</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=17" title="Edit section: Mechanical support"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Intra-aortic_balloon_pump" title="Intra-aortic balloon pump">Intra-aortic balloon pump</a> (IABP) – a device inserted into the aorta that mechanically raises the blood pressure. Use of Intra-aortic balloon pumps is not recommended in cardiogenic shock.<sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Ventricular_assist_device" title="Ventricular assist device">Ventricular assist device</a> (VAD) – A mechanical pump that helps pump blood throughout the body. Commonly used in short term cases of refractory primary cardiogenic shock.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li><a href="/wiki/Artificial_heart" title="Artificial heart">Artificial heart</a> (TAH)<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li> <li><a href="/wiki/Extracorporeal_membrane_oxygenation" title="Extracorporeal membrane oxygenation">Extracorporeal membrane oxygenation</a> (ECMO) – an external device that completely replaces the work of the heart.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup></li></ul> <div class="mw-heading mw-heading3"><h3 id="Treatment_goals">Treatment goals</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=18" title="Edit section: Treatment goals"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The goal of treatment is to achieve a urine output of greater than 0.5 mL/kg/h, a <a href="/wiki/Central_venous_pressure" title="Central venous pressure">central venous pressure</a> of 8–12 mmHg and a <a href="/wiki/Mean_arterial_pressure" title="Mean arterial pressure">mean arterial pressure</a> of 65–95 mmHg. In trauma the goal is to stop the bleeding which in many cases requires surgical interventions. A good urine output indicates that the kidneys are getting enough blood flow. </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=19" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Septic_shock" title="Septic shock">Septic shock</a> (a form of distributive shock) is the most common form of shock. Shock from blood loss occurs in about 1–2% of trauma cases.<sup id="cite_ref-EMB11_34-2" class="reference"><a href="#cite_note-EMB11-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> Overall, up to one-third of people admitted to the <a href="/wiki/Intensive_care_unit" title="Intensive care unit">intensive care unit</a> (ICU) are in circulatory shock.<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> Of these, cardiogenic shock accounts for approximately 20%, hypovolemic about 20%, and septic shock about 60% of cases.<sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=20" title="Edit section: Prognosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Sepsis_mortality.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/0/08/Sepsis_mortality.png/220px-Sepsis_mortality.png" decoding="async" width="220" height="145" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/08/Sepsis_mortality.png/330px-Sepsis_mortality.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/08/Sepsis_mortality.png/440px-Sepsis_mortality.png 2x" data-file-width="822" data-file-height="542" /></a><figcaption>Sepsis mortality</figcaption></figure> <p>The prognosis of shock depends on the underlying cause and the nature and extent of concurrent problems. Low volume, anaphylactic, and neurogenic shock are readily treatable and respond well to medical therapy. <a href="/wiki/Septic_shock" title="Septic shock">Septic shock</a>, especially septic shock where treatment is delayed or the antimicrobial drugs are ineffective, however has a mortality rate between 30% and 80%; cardiogenic shock has a mortality rate of up to 70% to 90%, though quick treatment with vasopressors and inotropic drugs, cardiac surgery, and the use of assistive devices can lower the mortality.<sup id="cite_ref-IrwinRippe_44-0" class="reference"><a href="#cite_note-IrwinRippe-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=21" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There is no evidence of the word shock being used in its modern-day form prior to 1743. However, there is evidence that <a href="/wiki/Hippocrates" title="Hippocrates">Hippocrates</a> used the word <i>exemia</i> to signify a state of being "drained of blood".<sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> Shock or "choc" was first described in a trauma victim in the English translation of <a href="/wiki/Henri_Fran%C3%A7ois_Le_Dran" title="Henri François Le Dran">Henri-François LeDran</a>'s 1740 text, Traité ou Reflexions Tire'es de la Pratique sur les Playes d'armes à feu (A treatise, or reflections, drawn from practice on <a href="/wiki/Gunshot_wound" title="Gunshot wound">gun-shot wounds</a>.)<sup id="cite_ref-46" class="reference"><a href="#cite_note-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> In this text he describes "choc" as a reaction to the sudden impact of a missile. However, the first English writer to use the word shock in its modern-day connotation was James Latta, in 1795.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2025)">citation needed</span></a></i>]</sup> </p><p>Prior to <a href="/wiki/World_War_I" title="World War I">World War I</a>, there were several competing hypotheses behind the <a href="/wiki/Pathophysiology" title="Pathophysiology">pathophysiology</a> of shock. Of the various theories, the most well regarded was a theory penned by <a href="/wiki/George_W._Crile" class="mw-redirect" title="George W. Crile">George W. Crile</a> who suggested in his 1899 monograph, "<i>An Experimental Research into Surgical Shock"</i>, that shock was quintessentially defined as a state of circulatory collapse (<a href="/wiki/Vasodilation" title="Vasodilation">vasodilation</a>) due to excessive nervous stimulation.<sup id="cite_ref-crile_47-0" class="reference"><a href="#cite_note-crile-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> Other competing theories around the turn of the century included one penned by Malcom in 1907, in which the assertion was that prolonged vasoconstriction led to the pathophysiological signs and symptoms of shock.<sup id="cite_ref-malcolm_48-0" class="reference"><a href="#cite_note-malcolm-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> In the following World War I, research concerning shock resulted in experiments by Walter B. Cannon of Harvard and William M. Bayliss of London in 1919 that showed that an increase in permeability of the capillaries in response to trauma or toxins was responsible for many clinical manifestations of shock.<sup id="cite_ref-wb_cannon_49-0" class="reference"><a href="#cite_note-wb_cannon-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-cannon-bayliss_report_50-0" class="reference"><a href="#cite_note-cannon-bayliss_report-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> In 1972 Hinshaw and Cox suggested the classification system for shock which is still used today.<sup id="cite_ref-hinshaw_cox_51-0" class="reference"><a href="#cite_note-hinshaw_cox-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-IrwinRippe_44-1" class="reference"><a href="#cite_note-IrwinRippe-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Shock_(circulatory)&action=edit&section=22" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-ITLSPg172-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-ITLSPg172_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-ITLSPg172_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-ITLSPg172_1-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-ITLSPg172_1-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-ITLSPg172_1-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-ITLSPg172_1-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-ITLSPg172_1-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-ITLSPg172_1-7"><sup><i><b>h</b></i></sup></a> <a href="#cite_ref-ITLSPg172_1-8"><sup><i><b>i</b></i></sup></a> <a href="#cite_ref-ITLSPg172_1-9"><sup><i><b>j</b></i></sup></a> <a href="#cite_ref-ITLSPg172_1-10"><sup><i><b>k</b></i></sup></a> <a href="#cite_ref-ITLSPg172_1-11"><sup><i><b>l</b></i></sup></a> <a href="#cite_ref-ITLSPg172_1-12"><sup><i><b>m</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite class="citation book cs1"><i>International Trauma Life Support for Emergency Care Providers</i> (8 ed.). 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Elsevier Health Sciences. p. 58. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1455700257" title="Special:BookSources/978-1455700257"><bdi>978-1455700257</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=High+Risk+Emergencies%2C+An+Issue+of+Emergency+Medicine+Clinics&rft.pages=58&rft.pub=Elsevier+Health+Sciences&rft.date=2010&rft.isbn=978-1455700257&rft.aulast=Tabas&rft.aufirst=Jeffrey&rft.au=Reynolds%2C+Teri&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DAc_XI7P3CKwC%26pg%3DPA58&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShock+%28circulatory%29" class="Z3988"></span></span> </li> <li id="cite_note-Stat2019Dis-4"><span class="mw-cite-backlink"><b><a href="#cite_ref-Stat2019Dis_4-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSmithLopezSilberman2019" class="citation journal cs1">Smith, N; Lopez, RA; Silberman, M (January 2019). "Distributive Shock". <i>StatPearls (Internet)</i>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/29261964">29261964</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=StatPearls+%28Internet%29&rft.atitle=Distributive+Shock&rft.date=2019-01&rft_id=info%3Apmid%2F29261964&rft.aulast=Smith&rft.aufirst=N&rft.au=Lopez%2C+RA&rft.au=Silberman%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShock+%28circulatory%29" class="Z3988"></span></span> </li> <li id="cite_note-5"><span class="mw-cite-backlink"><b><a href="#cite_ref-5">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.redcross.org/take-a-class/resources/learn-first-aid/shock">"Shock"</a>. <i>Red Cross</i>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20241104135009/https://www.redcross.org/take-a-class/resources/learn-first-aid/shock">Archived</a> from the original on 2024-11-04<span class="reference-accessdate">. Retrieved <span class="nowrap">2024-10-21</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Red+Cross&rft.atitle=Shock&rft_id=https%3A%2F%2Fwww.redcross.org%2Ftake-a-class%2Fresources%2Flearn-first-aid%2Fshock&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShock+%28circulatory%29" class="Z3988"></span></span> </li> <li id="cite_note-Tint10-6"><span class="mw-cite-backlink">^ <a href="#cite_ref-Tint10_6-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Tint10_6-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Tint10_6-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Tint10_6-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-Tint10_6-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-Tint10_6-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-Tint10_6-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-Tint10_6-7"><sup><i><b>h</b></i></sup></a> <a href="#cite_ref-Tint10_6-8"><sup><i><b>i</b></i></sup></a> <a href="#cite_ref-Tint10_6-9"><sup><i><b>j</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFTintinalli,_Judith_E.2010" class="citation book cs1">Tintinalli, Judith E. 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(2010). <i>Emergency Medicine: A Comprehensive Study Guide</i>. New York: McGraw-Hill Companies. pp. <span class="nowrap">174–</span>75. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-07-148480-0" title="Special:BookSources/978-0-07-148480-0"><bdi>978-0-07-148480-0</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Emergency+Medicine%3A+A+Comprehensive+Study+Guide&rft.place=New+York&rft.pages=%3Cspan+class%3D%22nowrap%22%3E174-%3C%2Fspan%3E75&rft.pub=McGraw-Hill+Companies&rft.date=2010&rft.isbn=978-0-07-148480-0&rft.au=Tintinalli%2C+Judith+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShock+%28circulatory%29" class="Z3988"></span></span> </li> <li id="cite_note-Centre_(UK)-8"><span class="mw-cite-backlink"><b><a href="#cite_ref-Centre_(UK)_8-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation book cs1"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/books/NBK63845/"><i>Assessing dehydration and shock</i></a>. 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Medical Research Committee, Special Investigation Committee on Surgical Shock and Allied Conditions: 19.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Special+Report+Series%2C+Medical+Research+Council%2C+London&rft.atitle=Note+on+Muscle+Injury+in+Relation+to+Shock&rft.volume=26&rft.issue=8&rft.pages=19&rft.date=1919&rft.aulast=Cannon&rft.aufirst=W.+B.&rft.au=Bayliss%2C+W.+M.&rft_id=https%3A%2F%2Fscholar.google.com%2Fscholar%3Fcluster%3D15587588554098844460%26hl%3Den%26as_sdt%3D5%2C39%26sciodt%3D0%2C39&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShock+%28circulatory%29" class="Z3988"></span></span> </li> <li id="cite_note-hinshaw_cox-51"><span class="mw-cite-backlink"><b><a href="#cite_ref-hinshaw_cox_51-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFCox1971" class="citation conference cs1">Cox, Barbara G. (1 October 1971). <a rel="nofollow" class="external text" href="https://archive.org/details/fundamentalmecha0000unse"><i>The Fundamental mechanisms of shock</i></a>. Proceedings of a Symposium Held in Oklahoma City, Oklahoma, October 1–2, 1971. <a href="/wiki/Advances_in_Experimental_Medicine_and_Biology" title="Advances in Experimental Medicine and Biology">Advances in Experimental Medicine and Biology</a>. Vol. 23. United States Navy Project THEMIS, <a href="/wiki/University_of_Oklahoma_Health_Sciences_Center" title="University of Oklahoma Health Sciences Center">University of Oklahoma Health Sciences Center</a>. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2F978-1-4615-9014-9">10.1007/978-1-4615-9014-9</a>. <a href="/wiki/EISSN_(identifier)" class="mw-redirect" title="EISSN (identifier)">eISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/2214-8019">2214-8019</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/9780306390234" title="Special:BookSources/9780306390234"><bdi>9780306390234</bdi></a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/0065-2598">0065-2598</a>. <a href="/wiki/LCCN_(identifier)" class="mw-redirect" title="LCCN (identifier)">LCCN</a> <a rel="nofollow" class="external text" href="https://lccn.loc.gov/72077225">72077225</a>. <a href="/wiki/OCLC_(identifier)" class="mw-redirect" title="OCLC (identifier)">OCLC</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/oclc/549969">549969</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=conference&rft.btitle=The+Fundamental+mechanisms+of+shock&rft.series=Advances+in+Experimental+Medicine+and+Biology&rft.pub=United+States+Navy+Project+THEMIS%2C+University+of+Oklahoma+Health+Sciences+Center&rft.date=1971-10-01&rft.eissn=2214-8019&rft_id=info%3Adoi%2F10.1007%2F978-1-4615-9014-9&rft_id=info%3Aoclcnum%2F549969&rft.issn=0065-2598&rft_id=info%3Alccn%2F72077225&rft.isbn=9780306390234&rft.aulast=Cox&rft.aufirst=Barbara+G.&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Ffundamentalmecha0000unse&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShock+%28circulatory%29" class="Z3988"></span> <span class="cs1-visible-error citation-comment"><code class="cs1-code">{{<a href="/wiki/Template:Cite_conference" title="Template:Cite conference">cite conference</a>}}</code>: </span><span class="cs1-visible-error citation-comment"><code class="cs1-code">|first=</code> missing <code class="cs1-code">|last=</code> (<a 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ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-label="Navbox32" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q178061" class="extiw" title="d:Q178061">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/R57">R57</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=785.50">785.50</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D012769">D012769</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb12013.htm">12013</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000039.htm">000039</a></li><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/emerg/531-overview">emerg/531</a> <a rel="nofollow" class="external text" href="https://www.emedicine.com/med/topic285.htm#">med/285</a> <a rel="nofollow" class="external text" href="https://www.emedicine.com/emerg/topic533.htm#">emerg/533</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Shock112" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar 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href="/wiki/Template:Shock_types" title="Template:Shock types"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Shock_types" title="Template talk:Shock types"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Shock_types" title="Special:EditPage/Template:Shock types"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Shock112" style="font-size:114%;margin:0 4em"><a class="mw-selflink selflink">Shock</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Distributive_shock" title="Distributive shock">Distributive</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Septic_shock" title="Septic shock">Septic shock</a></li> <li><a href="/wiki/Neurogenic_shock" title="Neurogenic shock">Neurogenic shock</a></li> <li><a href="/wiki/Anaphylactic_shock" class="mw-redirect" title="Anaphylactic shock">Anaphylactic shock</a></li> <li><a href="/wiki/Toxic_shock_syndrome" title="Toxic shock syndrome">Toxic shock syndrome</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Obstructive_shock" title="Obstructive shock">Obstructive</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Abdominal_compartment_syndrome" title="Abdominal compartment syndrome">Abdominal compartment syndrome</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Low-volume</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hemorrhage" class="mw-redirect" title="Hemorrhage">Hemorrhage</a></li> <li><a href="/wiki/Hypovolemia" title="Hypovolemia">Hypovolemia</a> <ul><li><a href="/wiki/Osmotic_shock" title="Osmotic shock">Osmotic shock</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cardiogenic_shock" title="Cardiogenic shock">Cardiogenic</a></li> <li><a href="/wiki/Spinal_shock" title="Spinal shock">Spinal shock</a></li> <li><a href="/wiki/Cryptic_shock" title="Cryptic shock">Cryptic shock</a></li> <li><a href="/wiki/Vasodilatory_shock" title="Vasodilatory shock">Vasodilatory shock</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Intensive_care_medicine321" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Intensive_care_medicine" title="Template:Intensive care medicine"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Intensive_care_medicine" title="Template talk:Intensive care medicine"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Intensive_care_medicine" title="Special:EditPage/Template:Intensive care medicine"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Intensive_care_medicine321" style="font-size:114%;margin:0 4em"><a href="/wiki/Intensive_care_medicine" title="Intensive care medicine">Intensive care medicine</a></div></th></tr><tr><td class="navbox-abovebelow" colspan="2"><div> <ul><li><a href="/wiki/Outline_of_health_sciences" title="Outline of health sciences">Health science</a></li> <li><a href="/wiki/Medicine" title="Medicine">Medicine</a></li> <li><a href="/wiki/Medical_specialty" title="Medical specialty">Medical specialities</a></li> <li><a href="/wiki/Respiratory_therapy" class="mw-redirect" title="Respiratory therapy">Respiratory therapy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">General terms</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Intensive_care_unit" title="Intensive care unit">Intensive care unit</a> (ICU)</li> <li><a href="/wiki/Neonatal_intensive_care_unit" title="Neonatal intensive care unit">Neonatal intensive care unit</a> (NICU)</li> <li><a href="/wiki/Pediatric_intensive_care_unit" title="Pediatric intensive care unit">Pediatric intensive care unit</a> (PICU)</li> <li><a href="/wiki/Coronary_care_unit" title="Coronary care unit">Coronary care unit</a> (CCU)</li> <li><a href="/wiki/Critical_illness_insurance" title="Critical illness insurance">Critical illness insurance</a></li> <li><a href="/wiki/Geriatric_intensive-care_unit" title="Geriatric intensive-care unit">Geriatric intensive-care unit</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Conditions</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Organ system failure</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <dl><dt>Shock sequence</dt> <dd><a href="/wiki/Systemic_inflammatory_response_syndrome" title="Systemic inflammatory response syndrome">SIRS</a></dd> <dd><a href="/wiki/Sepsis" title="Sepsis">Sepsis</a></dd> <dd><a href="/wiki/Sepsis#Definitions" title="Sepsis">Severe sepsis</a></dd> <dd><a href="/wiki/Septic_shock" title="Septic shock">Septic shock</a></dd> <dd><a href="/wiki/Multiple_organ_dysfunction_syndrome" title="Multiple organ dysfunction syndrome">Multiple organ dysfunction syndrome</a></dd></dl> <dl><dt>Other <a class="mw-selflink selflink">shock</a></dt> <dd><a href="/wiki/Cardiogenic_shock" title="Cardiogenic shock">Cardiogenic shock</a></dd> <dd><a href="/wiki/Distributive_shock" title="Distributive shock">Distributive shock</a></dd> <dd><a href="/wiki/Anaphylaxis" title="Anaphylaxis">Anaphylaxis</a></dd> <dd><a href="/wiki/Obstructive_shock" title="Obstructive shock">Obstructive shock</a></dd> <dd><a href="/wiki/Neurogenic_shock" title="Neurogenic shock">Neurogenic shock</a></dd> <dd><a href="/wiki/Spinal_shock" title="Spinal shock">Spinal shock</a></dd> <dd><a href="/wiki/Vasodilatory_shock" title="Vasodilatory shock">Vasodilatory shock</a></dd></dl> <dl><dt><a href="/wiki/Organ_dysfunction" title="Organ dysfunction">Organ failure</a></dt> <dd><a href="/wiki/Acute_kidney_injury" title="Acute kidney injury">Acute renal failure</a></dd> <dd><a href="/wiki/Acute_respiratory_distress_syndrome" title="Acute respiratory distress syndrome">Acute respiratory distress syndrome</a></dd> <dd><a href="/wiki/Acute_liver_failure" title="Acute liver failure">Acute liver failure</a></dd> <dd><a href="/wiki/Respiratory_failure" title="Respiratory failure">Respiratory failure</a></dd> <dd><a href="/wiki/Multiple_organ_dysfunction_syndrome" title="Multiple organ dysfunction syndrome">Multiple organ dysfunction syndrome</a></dd></dl> <ul><li><a href="/wiki/Neonatal_infection" title="Neonatal infection">Neonatal infection</a></li> <li><a href="/wiki/Polytrauma" title="Polytrauma">Polytrauma</a></li> <li><a href="/wiki/Coma" title="Coma">Coma</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Complications</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Critical_illness_polyneuropathy" title="Critical illness polyneuropathy">Critical illness polyneuropathy</a> / myopathy</li> <li><a href="/wiki/Critical_illness%E2%80%93related_corticosteroid_insufficiency" title="Critical illness–related corticosteroid insufficiency">Critical illness–related corticosteroid insufficiency</a></li> <li><a href="/wiki/Pressure_ulcer" title="Pressure ulcer">Decubitus ulcers</a></li> <li><a href="/wiki/Fungemia" title="Fungemia">Fungemia</a></li> <li><a href="/wiki/Stress_hyperglycemia" title="Stress hyperglycemia">Stress hyperglycemia</a></li> <li><a href="/wiki/Stress_ulcer" title="Stress ulcer">Stress ulcer</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Iatrogenesis" title="Iatrogenesis">Iatrogenesis</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Methicillin-resistant_Staphylococcus_aureus" title="Methicillin-resistant Staphylococcus aureus">Methicillin-resistant <i>Staphylococcus aureus</i></a></li> <li><a href="/wiki/Oxygen_toxicity" title="Oxygen toxicity">Oxygen toxicity</a></li> <li><a href="/wiki/Refeeding_syndrome" title="Refeeding syndrome">Refeeding syndrome</a></li> <li><a href="/wiki/Ventilator-associated_lung_injury" title="Ventilator-associated lung injury">Ventilator-associated lung injury</a></li> <li><a href="/wiki/Ventilator-associated_pneumonia" title="Ventilator-associated pneumonia">Ventilator-associated pneumonia</a></li> <li><a href="/wiki/Hemodialysis#Complications" title="Hemodialysis">Dialytrauma</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Diagnosis</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Arterial_blood_gas_test" title="Arterial blood gas test">Arterial blood gas</a></li> <li><a href="/wiki/Catheter" title="Catheter">Catheter</a> <ul><li><a href="/wiki/Arterial_line" title="Arterial line">Arterial line</a></li> <li><a href="/wiki/Central_venous_catheter" title="Central venous catheter">Central venous catheter</a></li> <li><a href="/wiki/Pulmonary_artery_catheter" title="Pulmonary artery catheter">Pulmonary artery catheter</a></li></ul></li> <li><a href="/wiki/Blood_culture" title="Blood culture">Blood cultures</a></li> <li><a href="/wiki/Screening_cultures" title="Screening cultures">Screening cultures</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Life_support" title="Life support">Life-supporting treatments</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Airway_management" title="Airway management">Airway management</a> and <a href="/wiki/Mechanical_ventilation" title="Mechanical ventilation">mechanical ventilation</a> <ul><li><a href="/wiki/Tracheal_intubation" title="Tracheal intubation">Tracheal intubation</a></li></ul></li> <li>Cardiac devices <ul><li><a href="/wiki/Intra-aortic_balloon_pump" title="Intra-aortic balloon pump">Intra-aortic balloon pump</a></li> <li><a href="/wiki/Ventricular_assist_device" title="Ventricular assist device">Ventricular assist device</a></li></ul></li> <li><a href="/wiki/Chest_tube" title="Chest tube">Chest tube</a></li> <li><a href="/wiki/Kidney_dialysis" title="Kidney dialysis">Kidney dialysis</a></li> <li><a href="/wiki/Early_goal-directed_therapy" title="Early goal-directed therapy">Early goal-directed therapy</a></li> <li><a href="/wiki/Induced_coma" title="Induced coma">Induced coma</a></li> <li>Nutritional supplementation <ul><li><a href="/wiki/Feeding_tube" title="Feeding tube">Enteral feeding</a></li> <li><a href="/wiki/Parenteral_nutrition" title="Parenteral nutrition">Total parenteral nutrition</a></li></ul></li> <li><a href="/wiki/Targeted_temperature_management" title="Targeted temperature management">Therapeutic hypothermia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Drugs</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Analgesic" title="Analgesic">Analgesics</a></li> <li><a href="/wiki/Antibiotic" title="Antibiotic">Antibiotics</a></li> <li><a href="/wiki/Antithrombotic" title="Antithrombotic">Antithrombotics</a></li> <li><a href="/wiki/Inotrope" title="Inotrope">Inotropes</a></li> <li><a href="/wiki/Intravenous_therapy" title="Intravenous therapy">Intravenous fluids</a></li> <li><a href="/wiki/Neuromuscular-blocking_drug" title="Neuromuscular-blocking drug">Neuromuscular-blocking drugs</a></li> <li><a href="/wiki/Drotrecogin_alfa" title="Drotrecogin alfa">Recombinant activated protein C</a></li> <li><a href="/wiki/Sedative" title="Sedative">Sedatives</a></li> <li><a href="/wiki/Stress_ulcer_prevention" class="mw-redirect" title="Stress ulcer prevention">Stress ulcer prevention</a> drugs</li> <li><a href="/wiki/Antihypotensive_agent" class="mw-redirect" title="Antihypotensive agent">Vasopressors</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_scoring" title="Medical scoring">ICU scoring systems</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/APACHE_II" title="APACHE II">APACHE II</a></li> <li><a href="/wiki/Glasgow_Coma_Scale" title="Glasgow Coma Scale">Glasgow Coma Scale</a></li> <li><a href="/wiki/PIM2" title="PIM2">PIM2</a></li> <li><a href="/wiki/SAPS_II" title="SAPS II">SAPS II</a></li> <li><a href="/wiki/SAPS_III" title="SAPS III">SAPS III</a></li> <li><a href="/wiki/SOFA_score" title="SOFA score">SOFA</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Physiology</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hemodynamics" title="Hemodynamics">Hemodynamics</a></li> <li><a href="/wiki/Hypotension" title="Hypotension">Hypotension</a></li> <li><a href="/wiki/Altered_level_of_consciousness" title="Altered level of consciousness">Level of consciousness</a></li> <li><a href="/wiki/Acid%E2%80%93base_disorder" title="Acid–base disorder">Acid–base imbalance</a></li> <li><a href="/wiki/Electrolyte_imbalance" title="Electrolyte imbalance">Water-electrolyte imbalance</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Organisations</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Society_of_Critical_Care_Medicine" title="Society of Critical Care Medicine">Society of Critical Care Medicine</a></li> <li><a href="/wiki/Surviving_Sepsis_Campaign" title="Surviving Sepsis Campaign">Surviving Sepsis Campaign</a></li> <li><a href="/wiki/European_Society_of_Paediatric_and_Neonatal_Intensive_Care" title="European Society of Paediatric and Neonatal Intensive Care">European Society of Paediatric and Neonatal Intensive Care</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related specialties</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anesthesiology" title="Anesthesiology">Anesthesiology</a></li> <li><a href="/wiki/Internal_medicine" title="Internal medicine">Internal medicine</a> <ul><li><a href="/wiki/Cardiology" title="Cardiology">Cardiology</a></li> <li><a href="/wiki/Neurology" title="Neurology">Neurology</a></li> <li><a href="/wiki/Pulmonology" title="Pulmonology">Pulmonology</a></li></ul></li> <li><a href="/wiki/Pediatrics" title="Pediatrics">Pediatrics</a></li> <li><a href="/wiki/Surgery" title="Surgery">Surgery</a></li> <li><a href="/wiki/Traumatology" title="Traumatology">Traumatology</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Signs_and_symptoms_relating_to_the_circulatory_system180" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Cardiovascular_system_symptoms_and_signs" title="Template:Cardiovascular system symptoms and signs"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Cardiovascular_system_symptoms_and_signs" title="Template talk:Cardiovascular system symptoms and signs"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Cardiovascular_system_symptoms_and_signs" title="Special:EditPage/Template:Cardiovascular system symptoms and signs"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Signs_and_symptoms_relating_to_the_circulatory_system180" style="font-size:114%;margin:0 4em"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Signs and symptoms</a> relating to the <a href="/wiki/Circulatory_system" title="Circulatory system">circulatory system</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Chest_pain" title="Chest pain">Chest pain</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Referred_pain" title="Referred pain">Referred pain</a></li> <li><a href="/wiki/Angina" title="Angina">Angina</a> <ul><li><a href="/wiki/Levine%27s_sign" title="Levine's sign">Levine's sign</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Auscultation" title="Auscultation">Auscultation</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Heart_sounds" title="Heart sounds">Heart sounds</a> <ul><li><a href="/wiki/Split_S2" title="Split S2">Split S2</a></li> <li><a href="/wiki/Third_heart_sound" title="Third heart sound">S3</a></li> <li><a href="/wiki/Fourth_heart_sound" title="Fourth heart sound">S4</a></li> <li><a href="/wiki/Gallop_rhythm" title="Gallop rhythm">Gallop rhythm</a></li></ul></li> <li><a href="/wiki/Heart_murmur" title="Heart murmur">Heart murmur</a> <ul><li><a href="/wiki/Systolic_heart_murmur" title="Systolic heart murmur">Systolic</a> <ul><li><a href="/wiki/Functional_murmur" title="Functional murmur">Functional murmur</a></li> <li><a href="/wiki/Still%27s_murmur" title="Still's murmur">Still's murmur</a></li></ul></li> <li><a href="/wiki/Diastolic_heart_murmur" title="Diastolic heart murmur">Diastolic</a> <ul><li><a href="/wiki/Pulmonary_insufficiency" class="mw-redirect" title="Pulmonary insufficiency">Pulmonary insufficiency</a></li> <li><a href="/wiki/Graham_Steell_murmur" title="Graham Steell murmur">Graham Steell murmur</a></li></ul></li> <li><a href="/wiki/Continuous_murmurs" title="Continuous murmurs">Continuous</a></li> <li><a href="/wiki/Carey_Coombs_murmur" title="Carey Coombs murmur">Carey Coombs murmur</a></li> <li><i><a href="/wiki/Mitral_insufficiency" class="mw-redirect" title="Mitral insufficiency">Mitral insufficiency</a></i> <ul><li><a href="/wiki/Presystolic_murmur" title="Presystolic murmur">Presystolic murmur</a></li></ul></li></ul></li> <li><a href="/wiki/Pericardial_friction_rub" title="Pericardial friction rub">Pericardial friction rub</a></li> <li><a href="/wiki/Heart_click" title="Heart click">Heart click</a></li> <li><a href="/wiki/Bruit" title="Bruit">Bruit</a> <ul><li><a href="/wiki/Carotid_bruit" title="Carotid bruit">carotid</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pulse" title="Pulse">Pulse</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Tachycardia" title="Tachycardia">Tachycardia</a></li> <li><a href="/wiki/Bradycardia" title="Bradycardia">Bradycardia</a></li> <li><a href="/wiki/Pulsus_paradoxus" title="Pulsus paradoxus">Pulsus paradoxus</a></li> <li><i>doubled</i> <ul><li><a href="/wiki/Pulsus_bisferiens" title="Pulsus bisferiens">Pulsus bisferiens</a></li> <li><a href="/wiki/Pulsus_bigeminus" class="mw-redirect" title="Pulsus bigeminus">Pulsus bigeminus</a></li></ul></li> <li><a href="/wiki/Pulsus_alternans" title="Pulsus alternans">Pulsus alternans</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Palpitations" title="Palpitations">Palpitations</a> <ul><li><a href="/wiki/Apex_beat" title="Apex beat">Apex beat</a></li></ul></li> <li><a href="/wiki/C%C5%93ur_en_sabot" title="Cœur en sabot">Cœur en sabot</a></li> <li><a href="/wiki/Jugular_venous_pressure" title="Jugular venous pressure">Jugular venous pressure</a> <ul><li><a href="/wiki/Cannon_A_waves" title="Cannon A waves">Cannon A waves</a></li></ul></li> <li><a href="/wiki/Hyperaemia" title="Hyperaemia">Hyperaemia</a></li> <li class="mw-empty-elt"></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a class="mw-selflink selflink">Shock</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cardiogenic_shock" title="Cardiogenic shock">Cardiogenic</a></li> <li><a href="/wiki/Obstructive_shock" title="Obstructive shock">Obstructive</a></li> <li><a href="/wiki/Hypovolemia" title="Hypovolemia">Hypovolemic</a></li> <li><a href="/wiki/Distributive_shock" title="Distributive shock">Distributive</a></li> <li>See further <a href="/wiki/Template:Shock" class="mw-redirect" title="Template:Shock">Template:Shock</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cardiovascular_disease" title="Cardiovascular disease">Cardiovascular disease</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Aortic_insufficiency" class="mw-redirect" title="Aortic insufficiency">Aortic insufficiency</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Collapsing_pulse" title="Collapsing pulse">Collapsing pulse</a></li> <li><a href="/wiki/De_Musset%27s_sign" title="De Musset's sign">De Musset's sign</a></li> <li><a href="/wiki/Duroziez%27s_sign" title="Duroziez's sign">Duroziez's sign</a></li> <li><a href="/wiki/M%C3%BCller%27s_sign" title="Müller's sign">Müller's sign</a></li> <li><a href="/wiki/Austin_Flint_murmur" title="Austin Flint murmur">Austin Flint murmur</a></li> <li><a href="/wiki/Mayne%27s_sign" title="Mayne's sign">Mayne's sign</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other <a href="/wiki/Endocardium" title="Endocardium">endocardium</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Endocarditis" title="Endocarditis">endocarditis</a>:</i> <a href="/wiki/Roth%27s_spot" title="Roth's spot">Roth's spot</a></li> <li><a href="/wiki/Janeway_lesion" title="Janeway lesion">Janeway lesion</a>/<a href="/wiki/Osler%27s_node" title="Osler's node">Osler's node</a></li> <li><a href="/wiki/Bracht%E2%80%93Wachter_bodies" title="Bracht–Wachter bodies">Bracht–Wachter bodies</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pericardium" title="Pericardium">Pericardium</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Cardiac_tamponade" title="Cardiac tamponade">Cardiac tamponade</a>/<a href="/wiki/Pericardial_effusion" title="Pericardial effusion">Pericardial effusion</a>:</i> <a href="/wiki/Beck%27s_triad_(cardiology)" title="Beck's triad (cardiology)">Beck's triad</a></li> <li><a href="/wiki/Ewart%27s_sign" title="Ewart's sign">Ewart's sign</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Rheumatic_fever" title="Rheumatic fever">rheumatic fever</a>:</i></li> <li><a href="/wiki/Anitschkow_cell" title="Anitschkow cell">Anitschkow cell</a></li> <li><a href="/wiki/Aschoff_body" title="Aschoff body">Aschoff body</a></li> <li><i><a href="/wiki/Electrocardiography" title="Electrocardiography">EKG</a></i> <ul><li><a href="/wiki/J_wave" title="J wave">J wave</a></li></ul></li> <li><a href="/wiki/Gallavardin_phenomenon" title="Gallavardin phenomenon">Gallavardin phenomenon</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Vascular_disease" title="Vascular disease">Vascular disease</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Artery" title="Artery">Arterial</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Aortic_aneurysm" title="Aortic aneurysm">aortic aneurysm</a></i> <ul><li><a href="/wiki/Cardarelli%27s_sign" title="Cardarelli's sign">Cardarelli's sign</a></li> <li><a href="/wiki/Oliver%27s_sign" title="Oliver's sign">Oliver's sign</a></li></ul></li> <li><i><a href="/wiki/Pulmonary_embolism" title="Pulmonary embolism">pulmonary embolism</a></i> <ul><li><a href="/wiki/Right_heart_strain" title="Right heart strain">Right heart strain</a></li></ul></li> <li><i><a href="/wiki/Radial_artery" title="Radial artery">radial artery sufficiency</a></i> <ul><li><a href="/wiki/Allen%27s_test" title="Allen's test">Allen's test</a></li></ul></li> <li><i><a href="/wiki/Pseudohypertension" title="Pseudohypertension">pseudohypertension</a></i></li> <li><i><a href="/wiki/Thrombus" title="Thrombus">thrombus</a></i> <ul><li><a href="/wiki/Lines_of_Zahn" title="Lines of Zahn">Lines of Zahn</a></li></ul></li> <li><a href="/wiki/Adson%27s_sign" title="Adson's sign">Adson's sign</a></li> <li><i><a href="/wiki/Arteriovenous_fistula" title="Arteriovenous fistula">arteriovenous fistula</a></i> <ul><li><a href="/wiki/Nicoladoni%E2%80%93Branham_sign" title="Nicoladoni–Branham sign">Nicoladoni–Branham sign</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Vein" title="Vein">Venous</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Friedreich%27s_sign" title="Friedreich's sign">Friedreich's sign</a></li> <li><a href="/wiki/Caput_medusae" title="Caput medusae">Caput medusae</a></li> <li><a href="/wiki/Kussmaul%27s_sign" title="Kussmaul's sign">Kussmaul's sign</a></li> <li><a href="/wiki/Trendelenburg_test" title="Trendelenburg test">Trendelenburg test</a></li> <li><i><a href="/wiki/Superior_vena_cava_syndrome" title="Superior vena cava syndrome">superior vena cava syndrome</a></i> <ul><li><a href="/wiki/Pemberton%27s_sign" title="Pemberton's sign">Pemberton's sign</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"><style data-mw-deduplicate="TemplateStyles:r1038841319">.mw-parser-output .tooltip-dotted{border-bottom:1px dotted;cursor:help}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1038841319"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1038841319"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1038841319"><link rel="mw-deduplicated-inline-style" 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