Investigative procedure

Assess patient:

• circulation - peripheral circulation (cold - vasoconstriction or warm - vasodilation), blood pressure, pulse, JVP, heart sounds,
• respiration - rate, type (Cheyne-Stokes, Kussmaul etc), chest examination, is patient well oxygenated (pink)
• assessment of cerebral function

If there is circulatory collapse then blood pressure is low and tachycardia. Causes include central (cardiac) failure or peripheral failure e.g. vasodilation, oligaemia. Central failure will cause increased JVP, pulmonary oedema etc. Peripheral failure may be the result of reduced blood volume or toxic vasodilatation.

First line investigations include:

• ECG
• CXR
• Hb and white cell count (blood culture)
• electrolytes
• x-match blood if required