Look for major bleeding
Scan the patient and surroundings for external blood loss. Control severe bleeding before completing the rest of the assessment.
How → Why → Practice
Assess circulation, recognize poor perfusion, and respond before the patient crashes.
Practice combining pulse, skin signs, capillary refill, mental status, bleeding, and blood pressure into one perfusion assessment.
0 of 3 lessons complete
Lesson 1
HOW: Perform a circulation and perfusion assessment
Control life-threatening bleeding immediately, then combine multiple findings rather than relying on one number.
Check a pulse
Assess rate, rhythm, strength, and location. Compare a peripheral pulse with a central pulse when perfusion is questionable.
Assess skin signs
Document color, temperature, and moisture. Pale, cool, clammy, mottled, or cyanotic skin may signal poor perfusion or another serious problem.
Check capillary refill
Use capillary refill as one supporting finding, especially in children. Consider temperature, age, lighting, and peripheral vascular disease.
Evaluate mental status and BP
Altered mentation and falling blood pressure can indicate worsening perfusion. A normal blood pressure does not rule out compensated shock.
Treat and trend
Control bleeding, maintain airway and breathing, prevent heat loss, position appropriately, expedite transport, and repeat your findings.
Think in patterns. Tachycardia, weak peripheral pulses, cool clammy skin, delayed refill, anxiety, and narrowing pulse pressure may appear before hypotension.
Lesson 2
WHY: Understand perfusion and shock
Perfusion is the delivery of oxygenated blood to tissues. Shock is inadequate tissue perfusion, regardless of the first blood-pressure reading.
Compensated shock
The body maintains blood pressure through tachycardia and vasoconstriction. Anxiety, cool skin, weak pulses, and delayed refill may appear early.
Decompensated shock
Compensation fails and blood pressure falls. Mental status, pulse quality, breathing, and skin findings often worsen rapidly.
Pulse pressure
A narrowing gap between systolic and diastolic pressure can support concern for worsening perfusion when combined with the patient presentation.
Central vs. peripheral pulse
A central pulse may remain palpable after a weak peripheral pulse disappears. This suggests reduced peripheral circulation and requires urgent reassessment.
Children compensate differently
Pediatric patients may maintain blood pressure until late. Appearance, heart rate, skin circulation, and work of breathing deserve close attention.
Trend beats snapshot
Repeated findings show whether perfusion is improving or deteriorating. Record times, interventions, and patient responses.
Quick knowledge check
Which patient may still be in compensated shock?
Full scenario mode: complete this assessment for the active patient. Teaching sections and patient changes are locked until you leave the scenario.
Lesson 3
PRACTICE: Assess, classify, act, and document
Review the patient, perform the perfusion assessment, decide whether it is normal, identify the pattern, choose the immediate priority, and document objectively.
Random patient
Assessment finding
0/4score
Coaching feedback
Example PCR documentation
Training content only. Follow your approved education, medical direction, and local protocols.