Hypotension resident survival guide
|
Hypotension Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Hypotension resident survival guide On the Web |
|
American Roentgen Ray Society Images of Hypotension resident survival guide |
|
Risk calculators and risk factors for Hypotension resident survival guide |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Definition
Hypotension is low blood pressure, especially in the arteries of the systemic circulation. It is considered to be a systolic BP of less than 90mmHg or diastolic of less than 60mmHg.
Causes
Life Threatening Causes
Common Causes
- ACE inhibitors
- Addison's disease
- Alpha blockers
- Anaphylaxis
- Beta blockers
- Bleeding
- Calcium channel blockers
- Diabetes mellitus
- Diuretics
- Hypoglycemia
- Hypothermia
- Hypovolemia
- Pregnancy
- Sepsis
- Shock
- Tricyclic antidepressants
Management
Algorithm summarizing the management of hypotension is shown below
| BP measurement | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Systolic BP < 90mmHg Or Diastolic BP < 60mmHg | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypotension | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| History and Symptoms Dizziness or lightheadedness Syncope (fainting) Rapid, shallow breathing Nausea Blurred vision Cold clammy, pale skin | Physical Examination Heart (irregular beats) Tilt table test | Laboratory Tests CBC (anemia) Glucose (Hypoglycemia, DM) Urinalysis Blood culture Cortisol (Addison's disease) BUN | EKG Echocardiogram Stress test Valsalva maneuver | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tilt table test positive | Tilt table test negative | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Neurocardiogenic syncope Continue with EKG and BP monitoring Beta blockers preferred initial treatment Alpha agonist SSRI Fludrocortisone 0.1mg/day Midodrine 2.5-10 TID Scopolamine Dual chamber pacing may be required | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| E01 | E02 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| F01 | F02 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
Don'ts
- Avoid or limit the use of alcohol
- Avoid standing for prolonged periods of time
- Don't cross legs while in a sitting position