Color
Pale skin suggests poor perfusion or blood loss, cyanosis indicates inadequate oxygenation, flushed skin may be caused by fever or heat exposure, and jaundice points to liver problems. Mottling can occur in late shock.
Temperature and Moisture
Cool and clammy skin is a classic sign of shock because of compensatory vasoconstriction. Hot, dry skin suggests heat stroke or fever, while hot and moist skin indicates heat exhaustion. Cold, dry skin may reflect exposure.
Capillary Refill
Capillary refill is most reliable in children under six. A delay of more than 2 seconds suggests poor perfusion. In adults, cold environments and other factors can affect it, so use it along with other findings.