The practical and scientific approach for Hypotensive patient

Blood pressure (BP) = Cardiac output (CO) x systematic vascular resistance (SVR)
	IS CO REDUCED?
	Yes	No
BP	90/70 mm Hg	90/40 mm Hg
Skin	Cool, blue	Warm, pink
Nail bed return	Slow	Rapid
Heart sounds	Muffled	Crisp
History/lab	Hypervolemic or cardiogenic etiology	or WBC and/or temperature
		Source of infection
		Immune compromise
		Severe liver disease
Working diagnosis	See next question	Septic shock/endotoxemia
	IS THE HEART TOO FULL?
	Yes	No
Presentation	Angina, dyspnea	Hemorrhage, dehydration
Signs	Cardiomegaly	Dry mucous membranes
	Extra heart sounds	tissue turgor
	JVP	Stool, gastric blood
Lab	ECG, x-ray	hematocrit
	Echocardiogram	BUN/creatinine
Working diagnosis	Cardiogenic shock	Hypovolemic shock
	WHAT DOES NOT FIT?
	Cardiac tamponade	Anaphylaxis
	Acute pulmonary hypertension	Spinal shock
	Right ventricular infarction	Adrenal insufficiency
	Overlapping multiple etiologies