- Peripheral shutdown – cold,* pale, cyanotic, increased capillary refill time (CRT)
- Renal – decreased urine output <0.5 ml/kg/hour
- Mental – disorientation, confusion, obtunded
- Abnormal heart rate**
- Increased JVP in obstructive shock
- Increased urea and creatinine
- Decreased haemoglobin (haemorrhagic causes)
- Deranged coagulation factors
- Increased venous lactate levels (>2 mmol/L), metabolic acidosis
- Decreased central venous oxygen saturations
*Distributive shock, e.g. septic shock is often initially characterised by high cardiac output and patients are often warm with well perfused skin. However late shock will result in peripheral shut down.
**Usually there is a tachycardia; however, in neurogenic shock due to loss of sympathetic outflow there may be a relative bradycardia associated with hypotension.