Effects of circulatory inadequacy on other organs

Acidotic sighing respirations

The acidosis produced by poor tissue perfusion in shock leads to rapid deep breathing.

Pale, cyanosed or cold skin A core/toe temperature difference of more than 2°C is a sign of poor skin perfusion.

Mental status

Agitation or depressed conscious level. Early signs of brain hypoperfusion are agitation and confusion, often alternating with drowsiness. Infants may be irritable but drowsy with a weak cry and hypotonia. They may not focus on the parent's face. These are important early cerebral signs of shock. Later the child becomes progressively drowsier until consciousness is lost.

Urinary output

Urine flow is decreased or absent in shock. Hourly measurement is helpful in monitoring progress. A minimum flow of 1 ml/kg/h in children and 2 ml/kg/h in infants indicates adequate renal perfusion.

NOTE: Poor capillary refill, core/toe temperature difference and differential pulse volumes are neither sensitive nor specific indicators of shock when used in isolation. There are helpful when used in conjunction with the other signs described.

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