Hypotension

Aka: Hypotension, Hypotension Causes

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II. Criteria: Hypotension (5th percentile for age)

  1. Term newborns (first month of life)
    1. Systolic Blood Pressure below 60 mm Hg
  2. Age 1 to 12 months
    1. Systolic Blood Pressure below 70 mmHg
  3. Age 1 to 10 years
    1. Systolic Blood Pressure below calculated cutoff (70mmHg + 2 * ageYears)
  4. Age 11 years and older
    1. Systolic Blood Pressure less than 90 mmHg

III. Causes

  1. Shock
    1. Hypovolemic Shock (Hemorrhagic Shock, Dehydration, Diabetic Ketoacidosis)
    2. Distributive Shock (Septic Shock, Neurogenic Shock, Anaphylaxis)
    3. Cardiogenic Shock (Congestive Heart Failure, Cardiomyopathy, Cardiac Contusion, valvular rupture)
    4. Obstructive Shock (Tension Pneumothorax, Pericardial Tamponade, massive Pulmonary Embolism)
  2. Non-shock states
    1. Orthostatic Hypotension
    2. Drug-Induced Hypotension
    3. Postprandial Hypotension
  3. Other causes of Hypotension
    1. Acidosis
    2. Adrenal Insufficiency
    3. Hypocalcemia
    4. Hypothyroidism
      1. Thyroid Stimulating Hormone (TSH) may be initially normal despite severe Hypothyroidism or Myxedema Coma
      2. Consider empiric Hypothyroidism management when Bradycardia, Hypotension and Hypothermia are present

IV. Evaluation

  1. See Shock
  2. See Orthostatic Hypotension
  3. See Drug-Induced Hypotension
  4. See Rapid Ultrasound in Shock
  5. See Inferior Vena Cava Ultrasound for Volume Status

V. References

  1. Shoenberger and Swaminathan in Swadron (Jan, 2024) EM:Rap

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