Hypotension 📉

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🧠 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

🕒 20 / 11 / 2025 — 23:24

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: _______
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