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Hypotension

Hypotension. Phone. What is BP? What is HR? Temperature? Mental status? Chest pain? Recent IV contrast or abx (anaphylaxis)? Admitting diagnosis?. Thoughts. Go see patient IMMEDIATELY ! Differential diagnosis: Cardiogenic: MI, PE, tamponade, tension pneumothorax Hypovolemia Sepsis

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Hypotension

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  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

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