Hypotension

 

History:

 

  • Blood loss
    • Vaginal/gastrointestinal bleeding
    • AAA
    • Ectopic
  • Fluid loss
    • Vomiting
    • Diarrhea
    • Fever
    • Infection
  • Cardiac ischemia (MI/CHF)
  • Medications
  • Allergic reaction
  • Pregnancy
  • History of poor oral intake

 

Significant Findings:

 

  • Restlessness
  • Confusion
  • Weakness
  • Dizziness
  • Weak, rapid pulse
  • Pale, cool, clammy skin
  • Delayed capillary refill
  • Coffee-ground emesis
  • Tarry stools

 

Differential:

 

  • Shock
    • Hypovolemic
    • Cardiogenic
    • Septic
    • Neurogenic
    • Anaphylactic
  • Ectopic pregnancy
  • Dysrhythmias
  • Pulmonary embolus
  • Trauma
  • Tension pneumothorax
  • Medication effect/overdose
  • Vasovagal
  • Physiologic (pregnancy)
  • Pulmonary edema (CHF)

 

Treatment:

 

  • Oxygen
  • Initiate IV/IO
  • 12-Lead EKG

 

Hypotension due to cardiogenic shock (tachycardia) ?

 

  • Yes

 

 

 

Non-trauma Non-cardiac (Possible Sepsis/Neurogenic)?

 

  • Yes

 

 

 

 

Improvement ?

 

  • No

 

    • OLMC: Request Additional Fluid

 

  • Yes

 

    • Notify receiving facility or contact
    • Medical Control

 

Hypotension due to bradycardia ?

 

  • Yes

 

 

PEARLS:

 

  • Consider all possible causes of shock and treat per appropriate protocol.
  • In the presence of cardiogenic shock and pulmonary edema/respiratory distress, fluid should be withheld in favor of giving pressers.
  • Hypotension can be defined as a systolic blood pressure of less than 90, however, shock is often present with a normal blood pressure and tachycardia may be the only manifestation.
  • Assess lung sounds frequently.
  • Push Dose Epi: Mix 1 ml of Epi 1:10,000 with 9 ml NS=Epi 1:100,000. Admin 1-2 ml (10-20 mcg) every 3-5 minutes for hypotension.