Adults

Hypotension

Diagnosis

Unexplained drop in blood pressure refractory to initial treatment

Diagnosis

Unexplained drop in blood pressure refractory to initial treatment

  1. Call for help

    • Ask: "Who will be the crisis manager?"
    • Crisis manager designates checklist reader

  2. Check...

  3. Inspect surgical field for bleeding

  4. Run IV fluids wide open

  5. Give vasopressors and titrate to response

    • MILD hypotension:
      • Give ePHEDrine or phenylephrine
    • SIGNIFICANT / REFRACTORY hypotension:
      • Administer norepinephrine; consider escalating to add vasopressin or EPINEPHrine
    • 5 - 25 mg IV - or -
    • 50 mg IM x 1
    • BOLUS: 50 - 200 MICROgrams IV
    • INFUSION: 0.5-1 MICROgrams/kg/min
    • BOLUS: 5 - 20 MICROgrams IV
    • INFUSION: 0.05 - 0.5 MICROgrams/kg/min
    • BOLUS: 1 - 2 units IV
    • INFUSION: 0.01 - 0.04 units/min
    • BOLUS: 4 - 10 MICROgrams IV
    • INFUSION: 0.01 - 0.1 MICROgrams/kg/min

  6. Turn FiO2 to 100% and minimize volatile anesthetics

  7. Consider...

    • Trendelenburg position
    • Additional IV access
    • Arterial line
    • Point of care ultrasound or echocardiography for diagnosis
    • Mechanical circulatory support

Patient weight

Between 30 kg and 250 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.