Assessment of circulation system

1. Assessment of
circulation system
presentation
DONE BY : IGIRIMBABAZI , DELPHIN

2. First steps
• Ensure personal safety. Wear apron and gloves as appropriate.
• First look at the patient in general to see if the patient appears
unwell.
• If the patient is awake, ask “How are you?”. If the patient appears
unconscious or has collapsed, shake him and ask “Are you alright?” If
he responds normally he has a patent airway, is breathing and has
brain perfusion. If he speaks only in short sentences, he may have
breathing problems. Failure of the patient to respond is a clear
marker of critical illness.

3. • This first rapid ‘Look, Listen and Feel” of the patient should take about 30 s and
will often indicate a patient is critically ill and there is a need for urgent help. Ask
a colleague to ensure appropriate help is coming.
• If the patient is unconscious, unresponsive, and is not breathing normally
(occasional gasps are not normal) start CPR according to the resuscitation
guidelines. If you are confident and trained to do so, feel for a pulse to determine
if the patient has a respiratory arrest. If there are any doubts about the presence
of a pulse start CPR.
• Monitor the vital signs early. Attach a pulse oximeter, ECG monitor and a non-
invasive blood pressure monitor to all critically ill patients, as soon as possible.
• Insert an intravenous cannula as soon as possible. Take bloods for investigation
when inserting the intravenous cannula.

4. 2. Taking vital signs
A. Blood pressure
B. Pulse(temporary artery, carotid ,brachial ,radial, femoral, popliteal
artery, posterior tibia artery, pedal
C. Temperature
D. Respiration rate
E. Oxygen saturation
F. Pain

5. 3. Assessing general appearance
First, take a moment to assess the patient’s general appearance. Is he
overly thin? Obese? Alert? Anxious? Note skin color, temperature,
turgor, and texture. Are his fingers clubbed? (Clubbing is a sign of
chronic hypoxia caused by a lengthy cardiovascular or respiratory
disorder.) If the patient is dark-skinned, inspect his mucous membranes
for pallor.

6. 4. Steps of assessment
4.1 Inspection
Look at the color of the hands and digits: are they blue, pink, pale?
Look thoroughly for external hemorrhage from wounds or drains or
evidence of concealed hemorrhage (e.g. thoracic, intra-peritoneal,
retroperitoneal or into gut). Intra-thoracic, intra-abdominal or pelvic blood
loss may be significant, even if drains are empty.
Inspect the vessels in the patient’s neck. The carotid artery should appear
to have a brisk, localized pulsation.
 The internal jugular vein has a softer, undulating pulsation.
Look for other signs of a poor cardiac output, such as reduced conscious
level and, if the patient has a urinary catheter, oliguria (urine volume < 0.5
mL kg-1 h-1).

7. 4. Steps of assessment
4.2 palpation
To palpate the carotid artery, lightly place your fingers just medial to the
trachea and below the angle of the jaw.
 The pulse should be regular in rhythm and have equal strength in the right
and left carotid arteries.
 You shouldn’t be able to detect any palpable vibrations, known as thrills.
 Don’t palpate both carotid arteries at the same time or press too firmly.
 If you do, the patient may faint or become bradycardic.
Count the patient’s pulse rate

8. Measure the capillary refill time . Apply cutaneous pressure for 5 s on
a fingertip held at heart level (or just above) with enough pressure to
cause blanching. Time how long it takes for the skin to return to the
color of the surrounding skin after releasing the pressure. The normal
value for CRT is usually < 2 s
Palpate peripheral and central pulses, assessing for presence, rate,
quality, regularity and equality. Barely palpable central pulses suggest
a poor cardiac output, whilst a bounding pulse may indicate sepsis.

9. Area to find pulse

10. Normal pulse rate
Neonates 120----160 beat/min
Pediatric 80-----130 beat/min
Adult 60---100 beat/min

11. 4.3 Auscultation
Normally, you should hear no vascular sounds over the carotid
arteries upon auscultation using the bell of the stethoscope.
If you detect a blowing, swishing sound, this is a bruit that results
from turbulent blood flow. A bruit can occur in patients with
arteriosclerotic plaque formation.
Auscultate the heart. Is there a murmur? Are the heart sounds
difficult to hear? Does the audible heart rate correspond to the pulse
rate?

12. Heart Auscultations

13. Key note
Normal blood pressure range
Neonates 67--84/35---53 mmhg
Pediatric 72----104/37---56 mmhg
Adult 120—139/80---90 mmhg
Respiration rate
Neonates 30-----60 breath/min
Pediatric 24-----40 breath/min
Adult 12----20 breath/min

14. Key note
Oxygen saturation
Neonates 93----97%
Pediatric 94----100%
Adult 95----100%
Normal pulse rate
Neonates 120----160 beat/min
Pediatric 80-----130 beat/min
Adult 60---100 beat/min

15. N.B after
assessment you
have to do a plan for
abnormal finding .