B14 · Very low blood circulation (shock)
Risk ⚠ URGENT Breathing and circulation
Definition
Circulation may become too weak to supply vital organs, which is an emergency needing rapid action.- Severe bleeding
- infection
- heart failure
- severe allergy
- Fast weak pulse
- very low blood pressure
- cold clammy skin
- confusion
- little urine
📋 Scenario
A trauma patient with a pelvic fracture is stable but has lost a large amount of blood at the scene.
Subjective (S): "I feel a little light-headed."
Objective (O): Pulse 104/min; blood pressure 112/70; respiratory rate 20/min; skin pale but warm; urine output 40 mL in the last hour; pelvic fracture; estimated blood loss 600 mL.
Assessment tools for this scenario: CP-BREATH Breathing & Circulation Check CP-SKIN Skin & Wound Score CP-ELIM Elimination Check
Validated scales to consider: NEWS2, SpO₂, ECG, Braden Scale, TIME wound chart, Bristol Stool Chart, bladder scan
**CarePath diagnosis:** Very low blood circulation (shock) related to severe bleeding (risk factors); no signs of the problem are present yet.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Check pulse, blood pressure, breathing, skin and mental state every 15 minutes. | Frequent checks catch early signs of shock, such as a rising pulse or falling pressure, in time to act, since bleeding can worsen quickly. |
| Control any bleeding and keep the patient warm. | Controlling bleeding stops further loss of blood volume, and warmth prevents chilling, which worsens circulation and clotting. |
| Give oxygen and fluids or blood as ordered. | Oxygen helps the remaining red cells deliver oxygen to organs, and fluids or blood restore the volume that keeps organs supplied. |
| Record urine output every hour. | Urine output reflects blood flow to the kidneys, so falling output is an early sign that organs are not getting enough blood. |
| Call emergency help at once if pulse is above 120/ min, systolic pressure below 90, skin cold and clammy, or the patient is confused. | These signs mean shock is developing, which can quickly become fatal, so immediate expert help is needed. |
**Expected outcomes**
- Pulse and blood pressure stay within the doctor's targets during treatment.
- Urine output stays at or above 30 mL/hour.
- Skin stays warm and the patient stays alert.
- No signs of shock develop; if they do, help is called within minutes.
**Linking the data to the diagnosis**
This is a risk statement: shock has not developed yet. The trauma patient has a pelvic fracture and an estimated blood loss of 600 mL. He says he feels a little light-headed. Pulse is 104/min, blood pressure 112/70, respiratory rate 20/min, skin pale but warm, and urine output 40 mL in the last hour. These findings are not shock, so the diagnosis rests on the risk from severe bleeding. It is urgent: if the listed warning signs appear, help is called first. The plan aims to keep pulse, pressure and urine output (30 mL/hour or more) in target, with warm skin and an alert patient.
CarePath diagnosis
Very low blood circulation (shock) related to severe bleeding (risk factors); no signs of the problem are present yet.
Interventions and rationale
Listed in priority order — for urgent statements the first action is to get help.
| Intervention | Rationale |
|---|---|
| 1. Check pulse, blood pressure, breathing, skin and mental state every 15 minutes. | Frequent checks catch early signs of shock, such as a rising pulse or falling pressure, in time to act, since bleeding can worsen quickly. |
| 2. Control any bleeding and keep the patient warm. | Controlling bleeding stops further loss of blood volume, and warmth prevents chilling, which worsens circulation and clotting. |
| 3. Give oxygen and fluids or blood as ordered. | Oxygen helps the remaining red cells deliver oxygen to organs, and fluids or blood restore the volume that keeps organs supplied. |
| 4. Record urine output every hour. | Urine output reflects blood flow to the kidneys, so falling output is an early sign that organs are not getting enough blood. |
| 5. Call emergency help at once if pulse is above 120/ min, systolic pressure below 90, skin cold and clammy, or the patient is confused. | These signs mean shock is developing, which can quickly become fatal, so immediate expert help is needed. |
Expected outcomes
- Pulse and blood pressure stay within the doctor's targets during treatment.
- Urine output stays at or above 30 mL/hour.
- Skin stays warm and the patient stays alert.
- No signs of shock develop; if they do, help is called within minutes.
Linking the data to the diagnosis
This is a risk statement: shock has not developed yet. The trauma patient has a pelvic fracture and an estimated blood loss of 600 mL. He says he feels a little light-headed. Pulse is 104/min, blood pressure 112/70, respiratory rate 20/min, skin pale but warm, and urine output 40 mL in the last hour. These findings are not shock, so the diagnosis rests on the risk from severe bleeding. It is urgent: if the listed warning signs appear, help is called first. The plan aims to keep pulse, pressure and urine output (30 mL/hour or more) in target, with warm skin and an alert patient.