What are the vital signs Is patient adequately perfused Are airway breathing and circulation ABCs compromised

Hypotension represents a medical emergency and requires immediate assessment and treatment. To determine lowest acceptable systolic BP for age (represents fifth percentile for age), use the guidelines in Table I—12. If systolic BP falls below these ranges, patient is considered to be hypotensive and metabolic demands of the body for both oxygen and nutrients may not be met. As treatment is occurring, a simultaneous search for cause of hypotension should begin.

B. Is patient tachycardic? Sinus tachycardia is the body's first modality to maintain adequate cardiac output in the face of hypo-volemia and suggests intravascular volume depletion.

C. How was BP measured? Be sure that cuff size is appropriate. Cuff that is too large may give a falsely low BP. Agitation and movement may alter result and make measurement inaccurate.

D. What has urine output been? Urine output is the best noninvasive marker of end-organ perfusion and, in the presence of normal renal function, provides an accurate reflection of intravascular volume status. For pediatric patients, urine output should be at least 1 mL/kg/h.

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