Hypotension 📉
Clinical guide for managing hypotension and shock. Assessment, causes, fluid resuscitation, vasopressors, and MAP calculator for on-call doctors.
🧠 Definition
- SBP <90 mmHg or a significant drop from baseline.
- May indicate shock — assess perfusion and context.
📞 What to Ask / Orders to Make
- Is patient symptomatic? (dizzy, confused)
- Manual BP both arms — is it real?
- Check: HR, RR, temp, CRT, GCS, SpO₂.
- Chest pain, SOB, bleeding, recent meds?
- Ask nurse to prep: ECG, IV access, O₂.
📋 Common Causes
- Hypovolaemia (bleeding, dehydration)
- Cardiac (MI, tamponade, dissection, PE)
- Sepsis, anaphylaxis
- Drugs: antihypertensives, sedatives
🧾 History
- Onset, duration, and prior BP trend.
- Symptoms: CP, SOB, fever, GI loss.
- Reason for admission.
- Drug history (esp. cardiac or opiates).
- Collateral if confused.
🩺 Examination
- Is patient well or shocked?
- A–C: RR, sats, chest sounds, CRT, HR, BP.
- Abdo: tenderness, peritonism, pulsatile mass.
- Neuro: GCS, new confusion, focal signs.
- Legs: oedema, DVT signs.
🔍 Investigations
- ECG — MI, arrhythmia, PE?
- ABG — pH, lactate.
- Bloods: FBC, U&E, LFTs, CRP, troponin, G&S.
- CXR — infection, fluid, dissection?
- Septic screen if fever/infection suspected.
- Catheter if resuscitating.
💊 Initial Management
- O₂ if unwell or SpO₂ < 94%.
- 2x large bore IVs. Draw bloods + G&S.
- 250–500ml crystalloid bolus if hypovolaemic.
- Call Reg early if shocked or deteriorating.
- Hold BP meds if contributing.
- Start Sepsis 6 if indicated.
⚠️ Escalation Criteria
- No response to fluids.
- Lactate ↑ or acidotic on ABG.
- Tachycardia, confusion, oliguria.
- Chest pain/ECG changes or suspicion of PE/AAA.
MAP Calculator
Estimate mean arterial pressure using SBP and DBP
Calculation Result
Mean Arterial Pressure:93.3 mmHg
🟩 MAP is within normal range. Continue current management and monitor.
Management goals should still be individualized based on clinical context.
Note Template
Ready-to-use clinical note structure
🕒 26 / 05 / 2026 — 12:27 ATRP re: hypotension Patient: [age] [sex] Admission Dx: [reason for admission] PMHx: [relevant comorbidities] 🧾 Hx: • Symptoms: [lightheaded, chest pain, SOB, confusion, GI loss] • Duration: [acute/chronic] • Fluid intake/output: [normal/reduced] • Meds: [antihypertensives, diuretics] 🩺 Exam: • HR: __ BP: __ CRT: __ RR: __ Temp: __ SpO₂: __ • Chest: [clear / creps / AE ↓] Abdo: [soft / tender / mass] • Peripheral pulses: [present / absent / unequal] • DVT signs: [yes/no] Neuro: [alert / confused] 📋 Impression: Likely cause(s): [hypovolaemia / sepsis / ACS / PE / other] 📌 Plan: • IV access, bloods • 250–500ml fluids • ECG + CXR • Septic screen if needed • Escalated to Reg: [yes/no] 👤 [Your Name], [Role] IMC: _______