The clinical presentation of shock can be dramatic, as in profound hypotension caused by hemorrhage from a gunshot wound. Or shock can be subtle, as in heart failure or, even paradoxically, hypertensive crisis.1 I2 No single vital sign or value is diagnostic of shock; all vital signs are insensitive in detecting and assessing the severity of shock. Measurement of blood pressure can be particularly difficult due to peripheral vascular disease, tachycardia with a small pulse pressure, and irregular rhythms such as atrial fibrillation. Although not specific, physical findings taken as a composite are useful in the assessment of patients in shock ( Table 2,6,-3).
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