- What are the other obs — HR, RR, sats, temp, consciousness, NEWS2?
- What is their usual BP? Any recent antihypertensives, opioids or sedatives?
- Are they bleeding, post-op or septic? What’s the urine output?
- What is the resus status / ceiling of care?
Do now
- Go and see them now — lie flat, A–E
- Two cannulas: FBC, U&E, lactate, cultures, G&S
- Fluid challenge and reassess
- ECG; look for bleeding, sepsis, cardiac cause
- Catheter and fluid balance; hold antihypertensives
Key doses
- 500 mL balanced crystalloid over < 15 min, reassess (250 mL if cardiogenic concern)
- Bleeding: major haemorrhage protocol
Typical adult doses — always check the BNF and your local guideline.
Call your senior if
- Not responding to fluids
- Lactate > 4, new confusion or reduced urine output
- Bleeding, chest pain, or any NEWS2 ≥ 7
Think of
- Sepsis
- Bleeding (GI, post-op)
- Cardiogenic (MI, arrhythmia)
- Drugs
- PE
- Anaphylaxis
Go deeper
The full walkthroughs behind this call.