Hypotension

What Is Hypotension?

Hypotension in prehospital care is defined as a systolic blood pressure below 90 mmHg (or Mean Arterial Pressure < 65 mmHg) in adults, signaling inadequate organ perfusion and potential shock state (hypovolemic, cardiogenic, septic, or anaphylactic).

Why Hypotension Matters on the Fireground

Persistent hypotension starves vital organs (brain, heart, kidneys) of oxygenated blood. In trauma, hypotension indicates decompensated shock (blood loss > 30%), requiring immediate fluid challenges or blood product transport to maintain cerebral perfusion.

Relevant NFPA Standards

• NREMT Standards: National Registry of Emergency Medical Technicians Practice Standards
• NFPA 455: Standard for Emergency Medical Services (EMS)

Field Procedures & Tactical Steps

1. Obtain accurate manual or NIBP blood pressure and calculate Mean Arterial Pressure (MAP = [2×DBP + SBP] / 3).
2. Position patient supine with legs elevated (unless cardiogenic shock or respiratory distress is present).
3. Establish large-bore IV access (14G or 16G in trauma) and initiate normal saline or Lactated Ringer's fluid bolus (500 mL to 1,000 mL).
4. For septic or neurogenic shock unresponsive to fluids: initiate vasopressor infusion (Norepinephrine or Epinephrine) per protocol.
5. Re-assess blood pressure and lung sounds every 5 minutes during fluid administration to monitor for fluid overload.

Common Context & Application

Identified during primary/secondary vital sign surveys on trauma, sepsis, anaphylaxis, cardiac arrest, and internal bleeding calls.

Frequently Asked Questions about Hypotension