Adult Critical Care Specialty (ACCS) Practice Exam

Which clinical sign is likely to be noted during a physical exam in a patient experiencing septic shock?

1. Cold extremities

2. High pulse pressure

3. Clear lung sounds

4. Warm skin

The correct answer is: Warm skin

In the context of septic shock, one clinical sign that may be noted during a physical exam is warm skin. Originally, septic shock can manifest as early sepsis, where the body attempts to compensate for the infection. This compensatory state often leads to vasodilation, resulting in increased blood flow to the skin, which can give it a warm, flushed appearance. This scenario occurs as part of the body's response to infection; the release of inflammatory mediators leads to vasodilation and increased capillary permeability, allowing for more blood to flow to peripheral tissues. As a result, patients may present with warm, flushed skin, particularly in the early stages of septic shock. In contrast, cold extremities typically indicate poor perfusion and might be more common in later stages as septic shock progresses, leading to reduced cardiac output and peripheral vasoconstriction. High pulse pressure is not a characteristic feature of septic shock; rather, there may be a narrowing of the pulse pressure due to changes in vascular resistance and fluid status. Clear lung sounds would suggest an absence of pulmonary complications, which is not typically observed in sepsis when patients may develop issues like pneumonia or acute respiratory distress. Understanding these signs and their implications can significantly enhance patient assessment and guide interventions