Hypotension can be a sign of significant underlying pathology, and if it is not rapidly identified and addressed, it can contribute to organ injury. Treatment of hypotension is best targeted at the underlying etiology, although this can be difficult to discern early in a patient’s disease course. Expedited bedside evaluation with rapid initiation of treatment based on the most likely underlying etiology is paramount, followed by serial reassessment of the patient’s condition.
Our recent issue Evaluation and Management of Hypotensive Patients in the Emergency Department synthesizes the key aspects of the presentation and evaluation of a patient with hypotension, including salient historical features, physical examination findings, and diagnostic tests that can help guide treatment.
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Here are a few key points:
- Hypotension is commonly defined as a systolic blood pressure (SBP) <90 mm Hg, mean arterial pressure (MAP) <65 mm Hg, or a decrease in SBP of ≥40 mm Hg compared to baseline for an adult patient.
- Treatment for hypotension is directed toward the underlying etiology.
- Swift treatment is essential, as sustained hypotension for at least 1 hour has been shown to nearly triple in-hospital mortality.4-6
- Hypotension can be due to decreased heart rate, stroke volume, or systemic vascular resistance. When it is prolonged or severe and associated with impaired organ perfusion, it can lead to shock.