Which of the following is NOT an early sign of impending shock in a child?

• A. Altered mental status
• B. Tachycardia
• C. Warm extremities
• D. Delayed capillary refill

Answer: (C)

In the early stages of shock in a child, the body tries to preserve blood flow to vital organs by activating the sympathetic system. This leads to a fast heart rate, signs of poor perfusion like delayed capillary refill, and mental status changes as the brain becomes mildly compromised. The skin often feels cool and clammy because blood is shunted away from the skin to the core. Warm extremities, on the other hand, indicate peripheral vasodilation and are more typical of later stages or different types of shock (such as distributive or septic shock). So while tachycardia, altered mental status, and delayed capillary refill fit the early compensatory response, warm extremities do not.