In shock, there’s a lot going on in the body – and if you know what you’re looking for, you can detect the signs early, and without ever touching a blood pressure cuff. When identifying shock remember that decompensated shock occurs when the body can’t maintain blood pressure anymore. Understanding the hows and whys is much more important than memorizing bullet points of individual conditions. Shock is shock. A patient that presents in a certain way should always make you think shock until proven otherwise. Then at some point, they’ll no longer be able to compensate and the blood pressure will drop. In response to shock, the body can change the size of the blood vessels. By increasing vascular tone, the blood vessels get smaller. You can see increased vascular tone on the outside of the body, especially around the skin. So remember: Increase in vascular tone = smaller blood vessels and increased pressure. If a patient is experiencing this, you will be able to see it on their skin. But pale, cool, moist skin isn’t the only way to detect shock during a primary assessment. When it comes to rising intracranial pressure (or brain herniation), you need to know that the vital signs are pretty much the opposite of what you’d see in shock. Being able to identify rising intracranial pressure allows you to recognize the criticality of the situation and get them transported to a hospital.
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