Which sign is most associated with early shock in a bleeding patient?

• A. Cold, clammy skin
• B. Restlessness, anxiety
• C. Bruising around the eyes
• D. Dilated pupils

Answer: (B)

Restlessness or anxiety is an early sign of hemorrhagic shock because when blood loss starts to reduce brain perfusion, the body’s initial response is a sympathetic surge that makes the patient appear uneasy, agitated, or worried. This mental-status change often appears before skin changes become obvious, so it’s a key clue that perfusion to vital organs is dropping.

Cold, clammy skin tends to show up as shock progresses and peripheral circulation is further compromised, so it’s more of a later indicator rather than an early cue. Bruising around the eyes is a trauma sign, not a direct indicator of shock physiology. Dilated pupils can occur for various reasons (head injury, medications, stress) and aren’t a reliable early sign of hemorrhagic shock on their own.