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Editorials
February 22, 1964

WARM HANDS, PINK SKIN, AND SHOCK

JAMA. 1964;187(8):610. doi:10.1001/jama.1964.03060210060016
Abstract

The terms "shock" and "peripheral circulatory failure" bring to mind patients with ashen-gray skin and cold extremities; yet there are numerous instances of severe hypotension associated with normal skin color and warm hands. Only in the latter instances is there true peripheral circulatory failure representing an inactive or inadequate response of the peripheral circulation to a decreased stroke output. In these patients circulatory reflexes are absent and the circulation behaves in a mechanical fashion. In the normal individual, cardiac output can change without altering the blood pressure for more than a few seconds, since reflex constriction or dilatation of arteries and veins acts, to prevent dangerous fluctuations of blood pressure. However, when circulatory reflexes have been lost, the blood pressure may readily fall to very low levels even when the patient is supine. Hypotension in these patients is secondary to acute dilatation of the venous system. As a result, more

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