Dissociative may result from oxygen not being released effectively by hemoglobin, as with carbon monoxide poisoning. A complete medical history should be completed and a thorough physical examination should be performed, including the state of consciousness, the pulse rate, the respiratory rate, the temperature, the blood pressure, the status of the skin and mucous membranes, capillary refilling, and urine output. Frequently repeated physical examinations with compared and analyzed serial measurements may provide the first evidence of shock. In compensated shock, neurologic status usually remains normal, but the pulse rate may be persistently elevated, the skin mottled, the extremities cool due to increased systemic vascular resistance, the capillary refilling prolonged, and the urinary output decreased. Capillary refilling time measured in the fingernail bed should be less than 2 seconds.
Hypotension usually is a late finding because of the activation of compensatory mechanisms.
Progression to uncompensated and irreversible shock, as manifested by hypotension, severe acidosis, oliguria or anuria, and lethargy and coma, can usually be prevented through early intervention. The pathophysiology of septic shock is markedly different from the other forms. In the early compensated stage, cardiac output is increased, systemic vascular resistance is decreased, and pulse pressure is widened. Tachycardia and tachypnea occur, but the Treatment Airway patency should be maintained, often requiring assisted ventilation. Oxygen should be administered, and efforts should be made to reduce the patient's oxygen requirements, which may become greater as a result of extreme body temperatures and the increased work of breathing.