Neurogenic Shock Assess for evidence of spinal cord injury or severe traumatic brain injury Anaphylaxis The provider should determine by history whether the patient has any known or suspected allergies to food, medications, or environmental allergens, as well as evaluate for the following physical findings: HEENT: Facial or mouth/tongue swelling Cardiac: Poor perfusion, hypotension as above Respiratory: Respiratory distress, wheezing, stridor Skin: Urticarial rash Septic Shock The provider should determine by history whether the patient has any underlying conditions which may predispose them to septic shock including neonatal age, innate or acquired immunodeficiency or immunosuppression (including malignancy, sickle cell disease and other causes of asplenia, bone marrow or solid organ transplant), or the presence of an indwelling central venous catheter or other invasive hardware In addition, they should evaluate carefully for evidence of end-organ dysfunction on physical examination as described by organ system below (and summarized in Table 10.2 ): Cardiac: Poor perfusion (diminished or bounding pulses, flash capillary refill or delayed [>3 seconds] capillary refill, abnormally cool or warm extremities, mottling) Respiratory: Tachypnea (from lung infection and/or metabolic acidosis), signs of respiratory distress or failure Hematologic: Rashes suspicious for disseminated intravascular coagulation such as petechiae or purpura; or a toxin-mediated process manifested as erythroderma Neurologic: Altered mental status Renal: Decreased urine output POCUS findings: Early findings may overlap with hypovolemic shock with evidence of fluid responsiveness (measured by respiratory variation in IVC diameter in the longitudinal view) and normal or hyperdynamic ventricular function Myocardial dysfunction may evolve with evidence of ventricular dysfunction Repeated assessment can be helpful Diagnostic Testing in Septic Shock Laboratory testing in suspected septic shock is focused on determining evidence of end-organ dysfunction and recommended testing is listed by organ system