Life threatening problems with airway or breathing should be treated first before assessment of the circulation. Some breathing problems such as tension pneumothorax or PE will cause circulatory collapse (obstructive shock) and will require urgent treatment as a priority.

Assessment of circulation

Fluid management
Fluid management
Fluid balance chart
Fluid balance chart

Assessment of volume status:

Assessment of the volume status would include the evaluation of the following:

Video: Circulation Assessment.

Signs of hypovolaemia

Signs of Hypervolaemia

What is the aetiology?

Determining the underlying cause of circulatory failure is important to direct further management of the patient.

  1. You have established the patient has evidence of poor tissue perfusion and therefore shock.
  2. Does the patient have signs of hypovolaemia?
  3. What is the cause of the hypovolaemia? (e.g. bleeding, inadequate fluid resuscitation, inappropriate diuretic use). A thorough review of the fluid balance charts, blood results and drug charts will be needed.
  4. Is there evidence of sepsis? (e.g. pyrexia, source of infection, warm to touch)
  5. Is there evidence of a cardiogenic cause? (e.g. raised JVP, pulmonary oedema, ECG changes consistent with myocardial ischaemia, arrhythmias)