The signs of shock are caused due to the circulation being compromised. The patient is being deprived of Oxygen and must be treated immediately. The patient may have a very rapid but weakened pulse; the pulse can be felt by palpating the femoral artery. Their breathing will likely be rapid as the body attempts to compensate for the decreased circulation which lowers the amount of hemoglobin being sent to the lungs. They may become very nervous, especially in their attempts to breathe. Many patients will have pale mucous membranes and their extremities may feel cool to the touch due to poor circulation or poor perfusion. Some patients in shock may have dilated pupils and be staring straight ahead. It is also possible for a patient in shock to vomit and experience seizure activity. The signs of respiratory distress may include changes in the effort, rate or rhythm in breathing. Clinical signs of respiratory distress include: difficulty or not wanting to exercise, wheezing or rattling when breathing, the patient may be open-mouth breathing, the breathing may be shallow or rapid, they may be panting and extending their neck out to breathe. Their tongue or gums may be bluish in color due to a lack of oxygen. Signs of poisoning can be numerous dependent on the poison exposed to and what system it affects. Many poisons will cause lethargy and a depressed state. A loss of appetite may be noted as well as emesis (vomiting) or a pu/pd (urinating/drinking more than usual) presentation. Difficulty walking (ataxia) is seen in some types of poisoning. Seizures can also be a sign of poisoning. An example of poisoning commonly seen at my clinic is exposure to mouse baits. Rodenticide poisoning is when the patient eats the mouse poison and it will cause blood clotting problems as well as some nervous system problems. These patients may have blood tests done to check kidney function as well radiographs taken to see if there is a fluid presence in the thorax. A blood clotting test may also be run. If the ingestion occurred recently the doctor may choose to induce emesis immediately upon arrival to the clinic. If it is unknown when the patient may have been poisoned with mouse bait it is important to remember they may not show signs for several days after eating the poison. Signs may include: lethargy, pale gums, trouble breathing, vomiting blood or a bloody nose. A medication to improve clotting ability (Vitamin K1), hospitalization and blood transfusions may be needed depending on the patient’s signs. A common trauma seen is a patient being hit by a car causing chest trauma. Chest trauma is of great concern when a hit by car arrives at the clinic. There can be fractured ribs, diaphragmatic hernia (tear in the diaphragm), Pneumothorax (buildup of air in the pleural space) and hemothorax (blood in the pleural space) present with a chest trauma. These patients will likely present with signs of shock and respiratory distress. Difficulty breathing, rapid heart rate, abnormal lung sounds, pale or blue mucous membranes and in a state of panic (nervousness) due to difficulty in breathing. Of course a hit by car patient could have many other traumas as well as thorax related concerns. Fractured legs, head injuries, lacerations or even degloving wounds (the skin has been peeled away from the underlying connective tissue).