Distinguishing categories of shock

Patients: 68 adults with more than  30 minutes of systolic blood pressure <90 mmHg
Examination: performed by medicine house officers.
Outcome: Category of shock classified by a single, blinded, experienced clinician using published consensus guidelines when available.
Results: The combination of estimation of the skin temperature (patient’s hand cooler than the examiner’s hand) and central venous pressure (CVP >7 cm) correctly categorized 52 of 68 cases (accuracy = 76%).
Although not explicitly stated, the categorization seems to be:
  • Septic shock (37 patients): warm hands; CVP  < 8 cm.
  • Cardiogenic shock (18 patients): cool hands, CVP  > 7 cm.
  • Hypovolemic shock (13 patients): cool hands, CVP  < 8 cm.

Comment: The authors used an odd definition of pulse pressure, “same/wider vs. thinner than examiner’s”, which may have prevented this sign from being significant. Other studies have found that a proportional pulse pressure < 25% is predictive of poor cardiac physiology (PMID: 2913385; PMID: 11420761)

This has been added to http://en.citizendium.org/wiki/Shock_(physiology).


Vazquez R, Gheorghe C, Kaufman D, & Manthous CA (2010). Accuracy of bedside physical examination in distinguishing categories of shock: a pilot study. Journal of hospital medicine : an official publication of the Society of Hospital Medicine, 5 (8), 471-4 PMID: 20945471

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