Management of Hypotension and Shock - Flowchart

Management of Hypotension and Shock - Flowchart

Management of Hypotension and Shock - Flowchart Management of Hypotension and Shock Management of Hypotension and Shock

Flowchart

Systolic BP < 90 mmHg or mean arterial pressure (MAP) < 65 mmHg or fall in systolic BP >40 mmHg with organ dysfunction and lactic acidosis

Systolic BP < 90 mmHg or mean arterial pressure (MAP) < 65 mmHg or fall in systolic BP >40 mmHg with organ dysfunction and lactic acidosis

Systolic BP < 90 mmHg or mean arterial pressure (MAP) < 65 mmHg or fall in systolic BP >40 mmHg with organ dysfunction and lactic acidosis

or or with

End

End

End

Assessment using ABCDE method
Key observations (Table 1.1)
Oxygen, ECG monitor, IV access
Stabilize airway and breathing
Correct major arrhythmia (Chapter 39)
If hypovolaemia or vasodilatation likely, lay the patient flat and elevate foot of bed

Assessment using ABCDE method
Key observations (Table 1.1)
Oxygen, ECG monitor, IV access
Stabilize airway and breathing
Correct major arrhythmia (Chapter 39)
If hypovolaemia or vasodilatation likely, lay the patient flat and elevate foot of bed

Assessment using ABCDE method
Key observations (Table 1.1)
Oxygen, ECG monitor, IV access
Stabilize airway and breathing
Correct major arrhythmia (Chapter 39)
If hypovolaemia or vasodilatation likely, lay the patient flat and elevate foot of bed

Table 1.1

Chapter 39

Focused assessment (see text)
Consider differential diagnosis (Table 2.1)
Urgent investigation (Table 2.3)

Focused assessment (see text)
Consider differential diagnosis (Table 2.1)
Urgent investigation (Table 2.3)

Focused assessment (see text)
Consider differential diagnosis (Table 2.1)
Urgent investigation (Table 2.3)

Table 2.1
Table 2.3

Give IV crystalloid 500 mL over 15 min
Reassess and repeat if no pulmonary oedema

Give IV crystalloid 500 mL over 15 min
Reassess and repeat if no pulmonary oedema

Give IV crystalloid 500 mL over 15 min
Reassess and repeat if no pulmonary oedema

Urgent echocardiography (Tables 2.4 and 2.5)
Start inotropic–vasopressor therapy (Tables 2.6 and 2.7)

Urgent echocardiography (Tables 2.4 and 2.5)
Start inotropic–vasopressor therapy (Tables 2.6 and 2.7)

Urgent echocardiography (Tables 2.4 and 2.5)
Start inotropic–vasopressor therapy (Tables 2.6 and 2.7)

2.4 2.5
2.6 2.7

Pulmonary oedema?

Pulmonary oedema?

Pulmonary oedema?

Yes

Yes

Yes

No

No

No

Review clinical features and results
Diagnosis and treatment of underlying disorder (Table 2.1)
Consider bladder catheter and invasive central venous/arterial pressure monitoring

Review clinical features and results
Diagnosis and treatment of underlying disorder (Table 2.1)
Consider bladder catheter and invasive central venous/arterial pressure monitoring

Review clinical features and results
Diagnosis and treatment of underlying disorder (Table 2.1)
Consider bladder catheter and invasive central venous/arterial pressure monitoring

Table 2.1