Emergency Algorithms

Hypotension + poor perfusion → ABCs, oxygen, IV access, monitor, fluids unless pulmonary edema → identify type.

• Septic: cultures, antibiotics, fluids, norepinephrine.
• Cardiogenic: ECG, troponin, echo, cautious fluids, pressors/inotropes, treat MI/arrhythmia.
• Obstructive: PE, tamponade, tension pneumothorax; relieve obstruction.
• Hypovolemic: fluids/blood, stop bleeding.

Vitals/orthostatics + ECG first. Red flags: exertional, chest pain, palpitations, abnormal ECG, structural heart disease, family history sudden death.

High-risk → admit/monitor. Low-risk vasovagal/orthostatic → outpatient follow-up and trigger management.

ECG changes or severe elevation → IV calcium → insulin/glucose ± albuterol → remove K with diuretic, binder, dialysis.

Confirm hypotonic hyponatremia → symptoms? → volume status → urine osm/Na.

Seizures/severe symptoms: hypertonic saline. Hypovolemic: normal saline. SIADH: fluid restriction.

ABCs → 2 large-bore IVs → CBC/coags/type & cross → resuscitate → upper vs lower source → endoscopy/colonoscopy after stabilization.