Low blood pressure

Act now

1. 1

   Lie flat, raise the legs (passive leg raise) to test fluid responsiveness.

3. 2

   IV access; fluid challenge if hypovolaemic and no signs of overload.

5. 3

   Hold antihypertensives and other culprit drugs.

Assess

• ABCDE. Look for shock: cool peripheries, capillary refill >2 s, confusion, low urine output, rising lactate.
• Think about the cause: sepsis, bleeding, dehydration, cardiac (ACS, arrhythmia, heart failure), anaphylaxis, PE, drugs (antihypertensives, opioids, sedatives), epidural.

Investigations

• Venous gas with lactate and Hb, FBC, U&E, CRP, cultures if infection suspected, ECG, group and save if bleeding.
• Fluid balance chart; consider urinary catheter for hourly output if shocked.

Manage

• General resuscitation (NICE CG174): 500 mL crystalloid (sodium 130–154 mmol/L) over less than 15 minutes, reassess, repeat up to 2 L.
• Suspected sepsis: follow NG253 — 250 mL boluses over 10–15 minutes, up to 1000 mL.
• Cardiac failure or renal failure: smaller boluses with senior input.
• Bleeding: blood products per major haemorrhage protocol; stop anticoagulants.

Escalate when