1. Hypotension

2. Phone What is BP? What is HR? Temperature? Mental status? Chest pain? Recent IV contrast or abx (anaphylaxis)? Admitting diagnosis?

3. Thoughts Go see patient IMMEDIATELY ! Differential diagnosis: –Cardiogenic: MI, PE, tamponade, tension pneumothorax –Hypovolemia –Sepsis –Anaphylaxis –Adrenal crisis

4. Bedside ABC’s and vitals –SBP <90 with evidence of inadequate tissue perfusion (cold,clammy,cyanotic, low uop) –Hypo/hyperthermia=think sepsis Is patient in shock? –Assess volume status: only cardiogenic has volume overload

5. Physical Orthostatic vitals HEENT: JVD (CHF, tamponade, PE, tension pneumothorax) Lungs: stridor, crackles, pleural effusion, wheeze CV: S3, rhythm abnormalities, cap refill Extrem: edema, mottling, clammy Neuro: mental status change

6. Management Call your senior-ICU/CCU transfer Labs: EKG, portable CXR, cardiac enzymes, CBC with diff, BMP, lactic acid, mixed venous gas, ABG, type and cross, cortisol, pancultures

7. Management Hypovolemia: –IV fluids-normal saline –Blood transfusion is suspect bleed Anaphylaxis –Epinephrine, diphenhydramine, steroids Adrenal crisis: –Draw cortisol BEFORE steroids given –Hydrocortisone 100 IV q 8 hours

8. Management Cardiogenic Shock: –Treat specific cause (MI-urgent cath, tamponade-pericardiocentesis, tension pneumothorax-needle thoracostamy, PE- thrombolytic thx vs. anticoagulation) Septic shock: –Aggressive fluid resuscitation, broad spectrum abx, pressors if needed