COVID-19 TRAINING FOR HEALTHCARE WORKERS 

Shock Evaluation at the Bedside 

M. Strehlow, MD 
 
LEARNING OBJECTIVES 
At the end of this lecture, the learner will be able to: 
1. Recognize 4 bedside markers of shock 
2. Determine presence of four bedside markers of shock 
 
KEY TEACHING POINTS 
1. Evaluation of multiple bedside markers in addition to vital signs is needed to detect shock 
early patients 
2. Bedside markers of shock include abnormal shock index, altered mental status, low urine 
output, and delayed capillary refill time 
 
OUTLINE 
1. Shock index 
a. Shock index = heart rate / systolic blood pressure 
b. Abnormal shock index is >0.9 
2. Capillary refill time 
a. Check on the thumb, palm or foot 
b. >4 seconds in adults is concerning for shock 
c. Note: Cool feet and hands during resuscitation that does not improve is also a marker 
of shock 
3. Urine output 
a. Urine output <0.5 mL per hour evaluated for at least 30 minutes is a sign of shock 
b. The initial urine output when a catheter is placed is not a good marker of shock as it is 
rarely possible to determine how long it has been since the person urinated previously 
4. Altered mental status 
a. Determine baseline mental status from talking with family, friends, other caregivers 
 b. Any score of Verbal, Pain, Unresponsive on AVPU scale if new for patient, is concerning 
for shocks 
 
REFERENCES/SUGGESTED READING: 
1. What every provider should know course edX and Digital Medic 
2. https://wikem.org/wiki/Undifferentiated_shock 
 
INFOGRAPHICS 
● GCS 
● General Appearance/AVPU and ABCs and implement oxygen and IV