Hypotension and/or Tachycardia

Airway control
Assure ventilation
Augment circulation (crystalloid +/– blood)

Definitive W/U

Administer crystalloid +/– blood

Hct >30
CVP >15

Consider cardiac dysfunction or tamponade

ECHO
Treat appropriately

Administer crystalloid +/– blood PCWP >15, Hct >30^*

Administer 500 mL crystalloid boluses until preload → maximal CI (Starling's curve)

Inotrope as indicated^*
Consider ECHO

Monitor CI deterioration

Maintain optimal PCWP^*

Crystalloid
Blood (Hct ≥30)

^* Monitor SVO₂, SVRI, and RVEDVI as additional markers of correction for perfusion and hypovolemia. Consider age-adjusted CI.

End

Central monitoring

CVP <15

CVP >15

Airway control
Assure ventilation
Augment circulation (crystalloid +/– blood)

VS Unstable
HR >120 and/or SBP <90

VS Normalized

Administer crystalloid +/– blood

Hct >30
CVP >15

VS unstable or acidosis worsens

VS Normalized

Insert PAC

CI <3.5; PCWP <15

CI <3.5; 15 < PCWP <20

CI <3.5; PCWP >20

Consider cardiac dysfunction or tamponade

ECHO
Treat appropriately