State of Circulation

In the category of the general state of the circulation, examples include: cyanosis and clubbing that might reflect an intracardiac right-to-left shunt; cold and clammy skin that might reflect cardiogenic shock; and an orthopneic patient who is sitting upright and may be in acute pulmonary edema.

In this example of clubbing from a patient with an intracardiac right-to-left shunt, note the cyanotic and bulbous finger tip as well as the loss of the normal angle between the base of the nail and the skin.