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Shock Assessment Questionnaire

Questions Your Doctor May Ask - and Why!

During a consultation, your doctor will use various techniques to assess the symptom: Shock. These will include a physical examination and possibly diagnostic tests. (Note: A physical exam is always done, diagnostic tests may or may not be performed depending on the suspected condition) Your doctor will ask several questions when assessing your condition. It is important to openly share any pertinent information to help your doctor make an accurate diagnosis.

It is also very important to bring an up-to-date list of all of your all medical conditions, medications including dosages, and names of numbers of any specialist you see.

Create your printable checklist by answering questions that your doctor may ask below:

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  1. What do you mean by shock?

    Why: Shock is difficult to define. The term "shock" is used to describe the physical and mental reaction to reduced blood circulation resulting in inadequate blood supply to body tissues.

  2. What is the cause of the shock?

    Why: There are 4 major causes of shock including hypovolemic shock (e.g. blood loss, fluid loss), septic shock (e.g. bacterial, fungi or viral infection), anaphylactic shock (e.g. allergic reaction) and cardiogenic shock (e.g. heart attack, heart arrhythmia, pulmonary embolism, pericardial tamponade, cardiomyopathy).

  3. Fluid intake?

    Why: may suggest inadequate intake of fluid and a contributor to hypovolemic shock e.g. poor fluid intake due to illness, anorexia, malnutrition or neglect.

  4. History of trauma?

    Why: may suggest hypovolemic shock due to bleeding.

  5. Past history of high blood pressure?

    Why: Blood pressure is reduced in shock relative to the person's previous blood pressure e.g. an elderly person whose usual blood pressure is 185/95 may be in shock with a blood pressure of 130/85. It is thus important to establish what the person's blood pressure was prior to becoming unwell.

  6. Past medical history?

    Why: Certain medical conditions increase the risk of septic shock such as diabetes mellitus, cirrhosis of the liver, leukemia and HIV infection; known heart or valvular disease increases the risk of cardiogenic shock.

  7. Past surgical history?

    Why: e.g. recent bladder catheterization, recent surgical procedure may increase the risk of sepsis such as those involving drainage tubes and foreign bodies; resection of small intestine may cause short bowel syndrome with resultant massive fecal fluid losses.

  8. Medications?

    Why: e.g. if the person is on a beta blocker or calcium channel blocker blood pressure medication, can not rely on using elevated heart rate as a sign of shock; some medications may increase the risk of sepsis such as chemotherapy; some medications taken in overdose may cause cardiogenic shock.

  9. Allergies?

    Why: e.g. drugs (such as antibiotics), X-Ray dyes, foodstuffs (such as shellfish, strawberries, peanuts), envenomation (such a bees) may suggest anaphylactic shock.

  10. Fever?

    Why: suggests septic shock (e.g. septicemia, pelvic inflammatory disease, peritonitis, pancreatitis) or cardiogenic shock (e.g. myocarditis or heart attack).

  11. Abdominal pain?

    Why: may suggest gastroenteritis, bleeding peptic ulcer, ruptured aortic aneurysm, pancreatitis, gall bladder disease, ectopic pregnancy, intestinal obstruction, intestinal ischemia.

  12. Chest pain?

    Why: may suggest heart attack, myocarditis, pericardial tamponade, pulmonary embolism.

  13. Vomiting?

    Why: may suggest the source of hypovolemic shock e.g. hyperemesis gravidarum, viral gastroenteritis, food poisoning, meningitis, cyclic vomiting syndrome, pyloric stenosis (projectile vomiting), intestinal obstruction, cholera, peritonitis and pancreatitis.

  14. Diarrhea?

    Why: may suggest the source of the hypovolemic shock e.g. viral gastroenteritis, cholera, food poisoning, ulcerative colitis, short bowel syndrome, amoebic dysentery.

  15. Bleeding?

    Why: e.g. rectal bleeding, melena (black tarry, offensive smelly stools), blood in vomit, bleeding from skin, vaginal bleeding - may suggest hypovolemic shock due to blood loss.

  16. Excess urination?

    Why: may be a source of the dehydration and a contributor to hypovolemic shock e.g. diabetes mellitus, diabetes insipidus, hyperparathyroidism, kidney failure, hypercalcaemia.

  17. Shortness of breath?

    Why: may suggest pulmonary embolism, tension pneumothorax, pericardial tamponade, pneumonia, heart arrhythmia or heart attack.

  18. Symptoms of hypovolemic shock?

    Why: e.g. postural dizziness (dizziness on standing up from a sitting position) and fainting. May have symptoms of the cause of hypovolemic shock such as bleeding, vomiting, diarrhea, excess urination or extensive burns.

  19. Symptoms of anaphylactic shock?

    Why: e.g. wheezing, swelling of tongue, hives, generalized skin redness, swelling of the face, seizures.

  20. Symptoms of dehydration?

    Why: e.g. thirst, postural dizziness, fainting and reduced urine output. If person with dehydration is a child may have less wet nappies, sunken eyes, lethargy, sunken fontanelle.

  21. Symptoms of pregnancy?

    Why: e.g. missed periods, nausea, tender breasts - may suggest ectopic pregnancy as cause of shock.

  22. Symptoms of urinary tract infection?

    Why: e.g. pain on urination, fever, urinary frequency, bladder tenderness, loin tenderness - may suggest septic shock.

  23. Symptoms of pneumonia?

    Why: e.g. fever, cough, shortness of breath, sputum production - may suggest septic shock.

  24. Symptoms of meningitis?

    Why: e.g. fever, headache, neck stiffness - may suggest septic shock.

  25. Symptoms of cholecystitis?

    Why: e.g. fever, continuous and severe pain in the right and central upper abdomen that may radiate to the back and shoulder. May be accompanied by nausea and vomiting. Jaundice may occur in 20% of cases. May suggest septic shock.

  26. Symptoms of pelvic inflammatory disease?

    Why: e.g. fever (if acute infection) , mild to severe pelvic pain, pain with intercourse, painful heavy or irregular periods, bleeding in-between the periods, abnormal and perhaps offensive pus-like vaginal discharge, painful or frequent urination - may suggest septic shock.

Conditions listing medical symptoms: Shock:

The following list of conditions have 'Shock' or similar listed as a symptom in our database. This computer-generated list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom.

Select from the following alphabetical view of conditions which include a symptom of Shock or choose View All.

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Conditions listing medical complications: Shock:

The following list of medical conditions have 'Shock' or similar listed as a medical complication in our database.


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