What are the four major signs of late shock?

• A. Falling blood pressure, irregular breathing, mottling or cyanosis, absent peripheral pulses
• B. Altered LOC, tachycardia, pale and cool skin, weak peripheral pulses
• C. Tachycardia, fever, diaphoresis, chest pain
• D. Bradycardia, cool extremities, dyspnea, edema

Answer: (A)

Late shock represents decompensation when the body's ability to maintain perfusion has failed. The four major signs reflect this critical drop in blood flow: a falling blood pressure, irregular or gasping respirations, mottling of the skin or cyanosis, and the absence of peripheral pulses. Falling pressure shows the heart can no longer sustain adequate cardiac output; irregular breathing arises as the brain and respiratory centers struggle with severe hypoperfusion and acidemia; mottling or cyanosis indicates extreme lack of oxygen delivery to the skin and extremities; and absent pulses confirm that blood flow to the limbs is severely compromised. These signs together point to a dangerous, life-threatening stage requiring immediate intervention. The other options include signs that can appear earlier in shock, or symptoms not typical of the late decompensated phase, such as fever, chest pain, or bradycardia, which do not define the late picture.