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Diagnose hämodynamischer Instabilität: Körperliche Zeichen und wichtige Tests

Hemodynamic compromise means inadequate tissue perfusion due to pump failure, volume loss, or vascular dysfunction. Early recognition is lifesaving.

Physical Exam Findings (Often First Clues)

Tachycardia – compensatory.
Hypotension – late sign; MAP <65 mmHg.
Tachypnea – metabolic acidosis compensation.
Cool, clammy skin – peripheral vasoconstriction.
Altered mental status – cerebral hypoperfusion.
Oliguria – renal hypoperfusion (<0.5 mL/kg/h).
Delayed capillary refill (>2 sec).

Confirmatory Tests

Test	What It Assesses
Arterial Blood Gas (ABG)	pH, lactate, PaO₂, PaCO₂ – metabolic acidosis, hypoxemia.
Serum Lactate	>2 mmol/L suggests tissue hypoperfusion; >4 mmol/L = severe.
Echocardiography (POCUS)	LV/RV function, volume responsiveness (IVC), pericardial effusion.
Central Venous Pressure (CVP) / ScvO₂	Preload, oxygen extraction (central line required).
Pulmonary Artery Catheter (Swan‑Ganz)	CO, PCWP, SVR, SvO₂ – gold standard but invasive.
Cardiac Output Monitoring (e.g., PiCCO, FloTrac)	Less invasive continuous CO, SVV, PPV.

Management Principle

Treat the cause (fluid resuscitation, vasopressors, inotropes, source control for sepsis, revascularization for MI, decompression for tamponade). Continuous reassessment is critical.

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