Key messages

• Timely reversal of hypotension with maintenance of tissue oxygen delivery at levels consistent with tissue needs is critical to avoid life-threatening complications such as multiple organ failure.

• The key to adequate management is to treat at the same time that monitoring is being instituted and diagnostic procedures initiated.

• Restoration of systolic blood pressure to at least 90 mmHg with reversal of clinical signs of shock (indicating an adequate tissue oxygen availability) is the primary objective of emergency therapy.

• The two major therapeutic strategies in hypotension are normalization of intravascular volume by administration of fluids (both crystalloids and colloids) in the volume-depleted patient and pharmacological support of arterial tone and cardiac contractility.

• In cardiogenic hypotension due to infarction, further management objectives include limiting further myocardial injury, restoring ventricular function, and determining whether there is a mechanical defect that requires invasive management.

• Key issues in the septic patient with hypotension are source control (antibiotic therapy, eradication of the septic focus) and support of oxygen delivery to match the elevated metabolic needs typical of sepsis.

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