Clinical assessment of hemodynamic instability

Abstract

Acute circulatory failure is a challenge to the clinician not only its treatment but maybe even more its recognition. Early recognition facilitates early resolution of the cause and adequate timely treatment of the circulatory failure and thus prevents further organ damage and improves the chances of survival. In the early days of trauma and shock, doctors had very few tools to make a correct diagnosis. They used the basic skills of listening to the patient, feeling the patient’s peripheral temperature and perfusion, and observing the color of the skin and the production of urine. From this we have developed the three windows that give us a view on the circulation without using monitoring/diagnsotic devices. By using the skills to look through the window of the brain, the skin, and the kidney, we can rapidly identify patients at a high risk of increased morbidity and mortality and thus can be used as a powerful warning signal. Clinical studies have shown that using these windows of circulatory failure may improve treatment and lead to improved outcome.