Assessment and treatment of perfusion abnormalities in the emergency patient

Perfusion abnormalities occur commonly in emergency patients secondary to a large number of underlying disease processes. The ability to recognize and effectively treat hypoperfusion forms the cornerstone of the emergency management of many of these patients. Global or systemic hypoperfusion can occur secondary to a reduction in the effective circulating intravascular volume (hypovolemic shock) or reduced ability of the heart to pump blood around the body secondary to reduced cardiac function (cardiogenic shock), obstruction to blood flow (obstructive shock), or maldistribution of the circulating intravascular volume (distributive shock). Global tissue hypoperfusion is initially assessed by a careful physical examination supplemented by measurement of hemodynamic and metabolic parameters. When treating hypoperfusion, the goal is to restore blood flow and oxygen delivery to the tissues rapidly, and the precise treatment used depends on the underlying cause and severity of the perfusion abnormality.