Monday, December 29, 2014


emDocs - December 29, 2014
Sandra Isnasious (MS-IV at UCLA David Geffen School of Medicine) and Manpreet Singh, MD (EM Chief Resident at Harbor-UCLA Medical Center) - Editor: Alex Koyfman, MD
Hypotension is typically defined as SBP < 90 mmHg, MAP < 60 mmHg, a decrease greater than 40 mmHg or 30% from patient’s baseline MAP, or a combination of any of the aforementioned. However, no clear definition of hypotension truly exists because it must be placed in context of the individual patient. What is considered a “normal” blood pressure may be dangerously low in a chronically hypertensive patient.
A good approach when dealing with hypotension at the bedside includes using the following systematic four step evaluation, which relies heavily on our bedside physical examination and ultrasound skills to evaluate each individual component:
  • Heart Rate
  • Volume Status
  • Cardiac Performance
  • Systemic Vascular Resistance
In general, hypotension results from a dysfunction in one or more of these components, so systematically going through these components and addressing them one at a time is a great way to understand the underlying disease pathophysiology our hypotensive ED patient faces."