pRRAPID

C

Circulation

Cardiovascular shock and Obstructive shock

INTRODUCTION

There are many causes of dysfunction of the circulatory system. This includes the numerous causes of shock as well as other cardiovascular disorders such as arrhythmias.

Shock is defined as a generalised state of tissue hypo-perfusion. It is an important concept to understand because although it has many causes, the clinical syndrome of shock has common symptoms and signs. If you are able to recognise these features early, further deterioration may be avoided. Progression of shock can lead to multi-organ failure and cardio-respiratory arrest. This chapter will define and discuss the management of shock.

A

Recognition

  • Vital signs
    • Heart rate
    • Pulse volume
    • Blood pressure
  • Skin & mucous membrane perfusion:
    • Capillary refill time (central & peripheral)
    • Skin temperature
    • Skin colour
  • Organ Perfusion:
    • Effects on breathing
    • Mental status
    • Urine output

Response

  • Intravenous access.  (Intraosseous needle if cannulation not rapidly established).
  • Take blood for blood gas (including lactate and ionised calcium), glucose stick test and laboratory tests including full blood count (FBC), urea & electrolytes (U&Es), renal and liver function, CRP, blood culture, cross-match & coagulation studies,(consider an ammonia level).
  • 3-lead cardiac monitoring and/or a 12-lead ECG
  • Fluid bolus (10mls/kg) and assess response

Table: Circulation Recognition and Response