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Deteriorating Patient

Signs of Hypoperfusion

February 15th, 2021


There are multiple clinical signs that suggest hypoperfusion, or shock.
  • Signs of Hypoperfusion

  • Tachycardia
  • Tachypnoea
  • Hypotension
  • Cool peripheries
  • Clamminess
  • Altered mental status
  • Reduced urine output (<0.5mL/kg/hr)
  • Pearls: Hypoperfusion

  • If shock is suspected, escalate immediately.
  • Patients with distributive shock (sepsis, anaphylaxis) are generally significantly vasodilated and will not be peripherally cool.

Prolonged Capillary Refill Time

  • How to Perform

  • Apply pressure to the nail bed until it blanches, release and measure the time taken for colour to return.
If the time is more then 2 seconds, then this suggests hypoperfusion.
  • Causes of Prolonged Capillary Refill Time

  • Shock
  • Dehydration
  • Reduced peripheral perfusion
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