Timely resuscitation blunts inflammation and mitochondrial damage, potentially reducing the burden of early and late morbidity. Initially, shock is reversible, but rapidly progresses to cellular injury, cell death, failure of critical organ systems, and an irreversible state that terminates in death. Subtle or atypical presentations of shock may require a high index of clinical suspicion. In such patients, the diagnosis may be challenging, especially since there is such interindividual variance in normal values for blood pressure. A subset of shock patients will have normal blood pressure (even hypertension is possible) many will also lack tachycardia. The basis for shock may be readily evident from the presentation, such as following trauma, or when symptoms or signs of hemorrhage, fluid loss, or sepsis are evident. ![]() ![]() Most patients will be hypotensive (mean arterial blood pressure < 60 mm Hg) and are often tachycardic, tachypneic, and exhibit overt end-organ dysfunction, such as oliguria, encephalopathy, or lactic acidosis ( Table 21–1). Shock is acute circulatory failure threatening multiple organ systems and producing a grave threat to survival.
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