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Deteriorating Patient

Signs of Hypoperfusion



  • 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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