# Does hypotension mean shock?



## nymedic9999 (Jul 1, 2015)

Say you had a 80 yom patient with pale cool clammy skin, a bp of 88/58, hr of 80 (no beta blockers), rr of 16 and a spo2 of 97 who experienced a syncopal episode secondary to possible dehydration.  Would you treat this patient as a shock patient with high flow o2 and rapid transport?  Does hypotension always equal shock?


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## DesertMedic66 (Jul 1, 2015)

I would lay the guy down and give him fluid IV. I wouldn't give him high flow oxygen and I wouldn't do a rapid transport. 

There are a ton of other assessments that I would do for the patient, BGL and EKG just to name a few. 

No hypotension does not always equal shock. A 30 year old female who weighs 100lbs may have a BP of 100/70 and that may be normal for her.


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## Brandon O (Jul 1, 2015)

nymedic9999 said:


> Would you treat this patient as a shock patient



Yes.



> with high flow o2 and rapid transport?



Eh.



> Does hypotension always equal shock?



No.


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## NomadicMedic (Jul 1, 2015)

Dehydration isn't shock. 

He presents with clinical signs of shock, however I'm betting they're transient due to bagel stimulation. My thought is a fluid bolus and lying supine would do wonders for his presentation. Much more than high flow O2 and a rapid transport. Reevaluate and treat as needed.


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## DesertMedic66 (Jul 1, 2015)

DEmedic said:


> Dehydration isn't shock.
> 
> He presents with clinical signs of shock, however I'm betting they're transient due to bagel stimulation. My thought is a fluid bolus and lying supine would do wonders for his presentation. Much more than high flow O2 and a rapid transport. Reevaluate and treat as needed.


Bagel stimulation? That sounds rather delicious.


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## chaz90 (Jul 1, 2015)

What kind of bagel are we stimulating? 

I know it's a common typo/auto correct, but I can't help but pile on 

Haha, we now return to your regularly scheduled programming...Yep. Treat with some fluid, monitor, slow and easy transport.


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## EMSComeLately (Jul 1, 2015)

What's their history? What's their usual bp?  Could skin condition be explained by other environmental factors?  Beta blockers aren't the only "inhibitors".  I'd want more before starting IVs and pushing fluids.


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## Akulahawk (Jul 1, 2015)

In short, no. hypotension doesn't always mean "shock." Sometimes it just means the patient has low blood pressure because they're dehydrated. Lay the patient down, provide fluids, observe...


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## NomadicMedic (Jul 1, 2015)

oh balls.


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## Brandon O (Jul 1, 2015)

Bagels do stimulate the vagal.


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## joshrunkle35 (Jul 1, 2015)

DesertEMT66 said:


> I would lay the guy down and give him fluid IV. I wouldn't give him high flow oxygen and I wouldn't do a rapid transport.
> 
> There are a ton of other assessments that I would do for the patient, BGL and EKG just to name a few.
> 
> No hypotension does not always equal shock. A 30 year old female who weighs 100lbs may have a BP of 100/70 and that may be normal for her.



This is word for word just about the same way I think and the same way I would treat.

ETA: with the exception that I wouldn't lay them down. I would ask them what position they think would be most comfortable for them.


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## Ewok Jerky (Jul 2, 2015)

Hypotenaion = low BP, typically SBP <90

Shock = deceased organ perfusion, usually wonky vitals at first and then signs of end organ damage.

A seagull that lives by a bay= ?


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## DrankTheKoolaid (Jul 2, 2015)

No blood pressure does not by any means equal shock. The sooner you can forget the whole less than 90 bs the better. What people seem to forget Or not know is if someone had a history of hypertension which their body has adapted to and all the sudden they become ill or injured and now have a systolic of 120 they can still be in shock


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## Carlos Danger (Jul 2, 2015)

nymedic9999 said:


> Say you had a 80 yom patient with pale cool clammy skin, a bp of 88/58, hr of 80 (no beta blockers), rr of 16 and a spo2 of 97 who experienced a syncopal episode secondary to possible dehydration.  Would you treat this patient as a shock patient with high flow o2 and rapid transport?  Does hypotension always equal shock?



Pale, cool skin and a MAP of 68 is concerning in an 80 year old, whose MAP is probably usually much higher. If they have a vagal episode, pass out, and then recover (skin color/temp and BP improves), then no problem - older folks are, unfortunately, susceptible to that sort of thing due to changes in our autonomic nervous systems as we age. You actually can make an argument that someone who is hypotensive AND has pale, cool skin is by definition in the early stages of shock, but since that can also be a very transient condition, the label "shock" is usually reserved for a condition that will not reverse itself.

But a BP that persists in that range and is accompanied by skin signs potentially means something very bad is going on, whether simple dehydration, a GI bleed, etc. Pale, cool skin means that the body is reflexively reducing blood flow to the skin and periphery in order to conserve oxygen and deliver it where it is needed more (heart, brain, kidneys).

What made you suspect dehydration? What were your differentials? My very first question would be what is his normal BP. History is very important here. Unless you are very confident in your diagnosis and ability to rule out something more serious, AND there is someone to stay with the patient to call back if necessary, transport is definitely indicated.


To summarize some of the points that were already made:

Shock is a state of inadequate end-organ perfusion. It is _not_ defined by blood pressure. There are different types (causes) and stages of shock that you should read about.

Hypotension simply means "lower than normal blood pressure", and is often defined as SBP <90 or 100, or MAP <65, but these are somewhat arbitrary and therefore vary from reference to reference. Someone with a BP of 88/58

Hypotension will cause inadequate end-organ perfusion (shock), if it is severe or prolonged. But simply having a lower BP than normal does not mean one is in shock.


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## PotatoMedic (Jul 2, 2015)

Ewok Jerky said:


> A seagull that lives by a bay= ?


A "Vagull"?

(That was for you DEmedic)


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## NomadicMedic (Jul 2, 2015)

FireWA1 said:


> A "Vagull"?
> 
> (That was for you DEmedic)



That's a gull who can never give a straight answer. A vague-ul.


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## Brandon O (Jul 2, 2015)

Not to be confused with the VAgull, which primarily roosts in Virginia.


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