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)
  • Rule out pulmonary edema
  • (congestive heart failure)

 

Treatment:

 

 

 

  • Oxygen

 

 

 

  • Initiate IV/IO

 

 

 

  • 12-Lead EKG

 

Hypotension due to cardiogenic shock (tachycardia) ?

 

  • Yes

 

 

 

 

 

Non-trauma Non-cardiac (no bradycardia) ?

 

  • Yes

 

 

 

 

 

Improvement ?

 

  • No

 

 

 

    • 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.
  • 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.

NREMR

National Registry Emergency Medical Responder

NREMT-I

National Registry EMT-Intermediate

NREMT

National Registry Emergency Medical Technician

NRP

National Registry Paramedic

NREMT-I

National Registry EMT-Intermediate

OLMC

Online Medical Control - Contact Medical Control