In shock all happens except

Shock is a common condition necessitating admission to the ICU or occurring in the course of critical care. Shock is defined by the presence of multisystem end organ hypoperfusion. Clinical indicators include reduced mean aerial pressure (MAP), tachycardia, cool skin and extremities, acute altered mental status, and oliguria. Hypotension is usually, though not always, present. The end result of multiorgan hypoperfusion is tissue hypoxia, oftenclinically manifested by lactic acidosis. Since the MAP is the product of cardiac output and systemic vascular resistance (SVR), reductions in blood pressure can be caused by decreased cardiac output and/or decreased SVR. Accordingly, the initial evaluation of a hypotensive patient should include an assessment of the adequacy of cardiac output; this should be pa of the earliest assessment of the patient by the clinician at the bedside once shock is contemplated . Clinical evidence of diminished cardiac output includes a narrow pulse pressure--a marker that correlates with stroke volume--and cool extremities with delayed capillary refill. Signs of increased cardiac output include a widened pulse pressure (paicularly with a reduced diastolic pressure), warm extremities with bounding pulses, and rapid capillary refill. If a hypotensive patient has clinical signs of increased cardiac output, one can infer that the reduced blood pressure is a result of decreased SVR. ref:harrison&;s principles of internal medicine,ed 18,pg no 2198