Identifying patients with circulatory failure

Patients with circulatory failure may have:

• Cool, clammy skin
• Cold hands and feet
• Prolonged capillary refill time (>2 seconds, after pressing on the forehead or sternum)
• Bradycardia (<50 bpm) or tachycardia (>100 bpm)
• Low blood pressure

Effects of shock include:

• Reduced urine output <0.5 ml/kg/hr (poor renal perfusion)
• Confusion (poor cerebral perfusion)

Causes of circulatory failure

Shock is inadequate perfusion of vital organs and may result from:

• Hypovolaemia - exclude bleeding
• Sepsis
• Anaphylaxis
• Cardiac failure
• Spinal cord injury - 'neurogenic' shock

Management of circulatory failure

Initial management of circulatory failure includes:

• Wide bore IV access
• Sending blood tests – blood samples for a full blood count, urea and electrolytes and blood group should be taken (if tests available)
• IV fluids should be given to all patients with shock unless a cardiac cause is suspected
• Treat the cause urgently:
  • Stop bleeding
  • Adrenaline for anaphylaxis
  • Antibiotics for sepsis
  • Vasopressors or inotropes may be indicated if no response to fluids and appropriate facilities exist