ICU Map

Hypotension

From confirming true hypotension to recognizing shock and its likely category.

RecognizeAssessDecideDifferentialInterveneReassess
Hypotension
Assessment StepConfirm true hypotension
Check cuff size and positioning, and repeat the measurement — an arterial line reading is more reliable if one is already in place.
Assessment StepAssess perfusion
Capillary refill, skin mottling, mentation, urine output, and lactate — these determine whether this is shock, not the blood pressure number alone.
Assessment StepAssess volume status and cardiac function
Jugular venous pressure, lung exam for congestion, and a passive leg raise or bedside ultrasound where available.
Decision PointIdentify likely category
The physical exam and point-of-care findings above usually place the picture into one of four overlapping categories.
Differential Branches (4)
1Branch
Physiologic MechanismDistributiveExplore Topic
Warm extremities, wide pulse pressure — vasodilation is the primary problem.
Diagnosis / EtiologySeptic shockExplore Topic
2Branch
Physiologic MechanismCardiogenicExplore Topic
Cool extremities, elevated JVP, pulmonary congestion — the heart itself is failing to generate adequate output.
Diagnosis / EtiologyAcute MI / decompensated heart failure
3Branch
Physiologic MechanismHypovolemicExplore Topic
Flat neck veins, dry mucous membranes, or an obvious source of fluid or blood loss.
Diagnosis / EtiologyHemorrhageExplore Topic
4Branch
Physiologic MechanismObstructiveExplore Topic
Elevated JVP without pulmonary congestion — something is mechanically preventing filling or output.
Diagnosis / EtiologyTension pneumothorax / tamponade / massive PE

An educational representation of clinical reasoning, not a diagnostic algorithm or personalized medical advice — always apply clinical judgment and institutional protocols.

Caution

Escalate — Red Flags & Critical Warnings

  • SBP < 90 mmHg or MAP < 65 mmHg with new confusion or oliguria — treat as shock and escalate immediately rather than waiting for a definitive diagnosis.
  • Hypotension with a new murmur, chest pain, or ischemic ECG changes — obtain an urgent ECG and echocardiogram to evaluate for cardiogenic shock.

Related Bedside Clinical Problems (20)

Bedside Presentations
Sudden Hypoxemia

Bedside triage of acute desaturation: signal verification, immediate danger screening (DOPE / tension pneumothorax), oxygen escalation ladder, and mechanism-based differential.

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Sudden Ventilator Deterioration & High Airway Pressures

Algorithmic troubleshooting of acute patient-ventilator collapse: the DOPE framework, peak vs plateau pressure differentiation, auto-PEEP evaluation, and manual bagging separation.

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Acute Hypotension & Undifferentiated Shock

Rapid bedside hemodynamic categorization: confirming MAP < 65 mmHg, assessing peripheral perfusion, POCUS cardiac/IVC profiling, and differentiating hypovolemic, distributive, cardiogenic, and obstructive etiologies.

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Linked Deep-Dive Topics (7)

Reference Knowledge
Shock: Foundational Critical Care Frameworkcardiovascular

Cellular dysoxia, DO2/VO2 physiology, the 4 shock phenotypes, dynamic fluid responsiveness (PLR/PPV) vs fluid tolerance (VExUS), and vasoactive pharmacology.

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Septic Shockcardiovascular

The subset of sepsis with profound circulatory and cellular/metabolic abnormality — clinically identified by a vasopressor requirement to maintain MAP ≥ 65 mmHg plus lactate > 2 mmol/L despite adequate fluid resuscitation.

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Cardiogenic Shockcardiovascular

Primary pump failure, SCAI staging (A–E), PAC hemodynamics (CPO, PAPi), inotrope selection, emergent revascularization, and mechanical circulatory support.

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Obstructive Shockcardiovascular

Extracardiac mechanical barriers to filling or ejection: Massive PE, Cardiac Tamponade, Tension Pneumothorax, and Auto-PEEP.

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Acute Right Ventricular Failurecardiovascular

RV anatomy and ischemia spiral, ventricular interdependence (D-sign), echocardiographic metrics (TAPSE, S', PAPi, VExUS), and the 4-pillar resuscitation strategy.

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Pulmonary Hypertension & Acute Decompensationcardiovascular

Hemodynamic classification, right ventricular afterload reduction, selective pulmonary vasodilation, and pulmonary hypertensive crisis management.

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Acute Heart Failure & Cardiogenic Congestioncardiovascular

Hemodynamic phenotypes (SCAPE vs ADHF vs Cardiogenic Shock), non-invasive positive pressure ventilation, high-dose vasodilator algorithms, loop diuretics, and sequential nephron blockade.

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