The diagnosis of<unk> is commonly based on a combination of symptoms, physical examination, and laboratory tests. Many signs and symptoms are not sensitive or specific for<unk>  and as such many clinical decision making tools have been developed to identify<unk> at an early stage. A high degree of suspicion is necessary for the proper diagnosis of<unk>  The first change seen in<unk> is increased cardiac output followed by a decrease in mixed venous oxygen saturation (SmvO2) as measured in the pulmonary artery via a pulmonary artery catheter. Central venous oxygen saturation (ScvO2) as measured via a central line correlates well with SmvO2 and are easier to acquire. If<unk> progresses anaerobic metabolism will begin to occur with an increased blood lactic acid as the result. While many laboratory tests are typically performed, there is no test that either makes or excludes the diagnosis. A chest X-ray or emergency department ultrasound may be useful to determine volume status.
Shock 
Shine 
Hand
Skull
Head
Mouth
Shoe
Kidney