All EMS presentations
General MedicalClinical presentation

Hypotension / shock

A streamlined, differential-led presentation for rapid clinical review.

Clinical snapshot

Twenty-second review

  • Hypotension results when cardiac output or vascular tone cannot maintain organ perfusion, including hypovolemic, distributive, cardiogenic, and obstructive mechanisms.
  • Altered mentation, cool or mottled skin, weak pulses, chest pain, dyspnea, hemorrhage, fever, or persistent low pressure indicates shock until assessed.
  • Keep measurement error or low baseline in the differential; overlapping or concurrent illness remains possible.
  • For hypotension / shock, trends and combinations of findings are more informative than one isolated vital sign.
Differentials

Compare the clinical patterns

The repeated material is grouped inside each possibility. Open only the condition you need.

Serious4 conditions
HemorrhagicTime-sensitive high-risk possibility

HPI

Clarify bp and trend; baseline if known; poor perfusion.

Signs & symptoms

Poor perfusion plus cause-specific findings requires rapid treatment.

Focused exam

Perform a targeted cardiorespiratory, neurologic, abdominal, skin, and hydration assessment guided by the history; Assess function against baseline rather than relying on a single normal-looking measurement.

Brief pathophysiology

Hemorrhagic may cause hypotension / shock through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

Hemorrhage is a trend diagnosis: tachycardia and narrowing pulse pressure may precede hypotension. Age, pregnancy, medications, and pacing can blunt expected responses.

Heart rate (bpm)

Often rises

Tachycardia is a common compensatory response but may be absent.

Pulse pressure (mmHg)

May narrow

Narrowing pulse pressure can reflect reduced stroke volume.

Blood pressure (mmHg)

May fall late

A normal pressure does not exclude significant compensated hemorrhage.

MAP (mmHg)

May fall

A falling trend supports worsening perfusion; interpret with mental status and skin signs.

Front-load in the triage report

  • Hemorrhagic: Poor perfusion plus cause-specific findings requires rapid treatment.
  • BP and trend.
  • Baseline if known.
SepticTime-sensitive high-risk possibility

HPI

Clarify baseline if known; poor perfusion; suspected cause: hemorrhage, sepsis, dehydration, cardiac, anaphylaxis.

Signs & symptoms

Poor perfusion plus cause-specific findings requires rapid treatment.

Focused exam

Assess function against baseline rather than relying on a single normal-looking measurement; Assess bleeding, hydration, infection, cardiac and lung findings, DVT risk, abdominal or pelvic pathology, and medication effects.

Brief pathophysiology

Septic may cause hypotension / shock through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

No single vital sign diagnoses sepsis. New tachypnea, abnormal temperature, tachycardia, or falling pressure—especially with altered mentation or poor perfusion—supports organ dysfunction and urgency.

Respiratory rate (breaths/min)

May rise early

Tachypnea is included in NEWS2 and can precede overt hypotension.

Temperature (°C)

High or low

Absence of fever does not exclude sepsis; hypothermia is concerning.

Heart rate (bpm)

Often rises

Tachycardia is common but may be blunted by age or medication.

Blood pressure (mmHg)

May fall

Relative hypotension and trend matter; profound hypotension can be late.

Front-load in the triage report

  • Septic: Poor perfusion plus cause-specific findings requires rapid treatment.
  • Baseline if known.
  • Poor perfusion?
CardiogenicTime-sensitive high-risk possibility

HPI

Clarify poor perfusion; suspected cause: hemorrhage, sepsis, dehydration, cardiac, anaphylaxis; bleeding.

Signs & symptoms

Poor perfusion plus cause-specific findings requires rapid treatment.

Focused exam

Assess function against baseline rather than relying on a single normal-looking measurement; Assess bleeding, hydration, infection, cardiac and lung findings, DVT risk, abdominal or pelvic pathology, and medication effects.

Brief pathophysiology

Cardiogenic may cause hypotension / shock through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

Shock can be present before profound hypotension. Trend perfusion, mental status, pressure, and pulse characteristics; the direction varies with cause and treatment.

Blood pressure (mmHg)

May fall

Relative change from baseline may be important before absolute hypotension appears.

MAP (mmHg)

May fall

A falling MAP supports impaired perfusion but is not the only endpoint.

Heart rate (bpm)

Often rises

Tachycardia is common; neurogenic, toxic, paced, or medication effects can alter the response.

Pulse pressure (mmHg)

May narrow

Narrow pulse pressure can reflect reduced stroke volume, although distributive states may differ.

Front-load in the triage report

  • Cardiogenic: Poor perfusion plus cause-specific findings requires rapid treatment.
  • Poor perfusion?
  • Suspected cause: hemorrhage, sepsis, dehydration, cardiac, anaphylaxis.
Obstructive shockTime-sensitive high-risk possibility

HPI

Clarify suspected cause: hemorrhage, sepsis, dehydration, cardiac, anaphylaxis; bleeding; chest/abdominal/back pain.

Signs & symptoms

Poor perfusion plus cause-specific findings requires rapid treatment.

Focused exam

Assess function against baseline rather than relying on a single normal-looking measurement; Assess bleeding, hydration, infection, cardiac and lung findings, DVT risk, abdominal or pelvic pathology, and medication effects.

Brief pathophysiology

Obstructive shock may cause hypotension / shock through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

Shock can be present before profound hypotension. Trend perfusion, mental status, pressure, and pulse characteristics; the direction varies with cause and treatment.

Blood pressure (mmHg)

May fall

Relative change from baseline may be important before absolute hypotension appears.

MAP (mmHg)

May fall

A falling MAP supports impaired perfusion but is not the only endpoint.

Heart rate (bpm)

Often rises

Tachycardia is common; neurogenic, toxic, paced, or medication effects can alter the response.

Pulse pressure (mmHg)

May narrow

Narrow pulse pressure can reflect reduced stroke volume, although distributive states may differ.

Front-load in the triage report

  • Obstructive shock: Poor perfusion plus cause-specific findings requires rapid treatment.
  • Suspected cause: hemorrhage, sepsis, dehydration, cardiac, anaphylaxis.
  • Bleeding?
Common2 conditions
Volume depletionCommon presentation pattern

HPI

Clarify bp and trend; baseline if known; poor perfusion.

Signs & symptoms

Fluid loss, poor intake, vasodilators, or recent dialysis may reduce preload.

Focused exam

Perform a targeted cardiorespiratory, neurologic, abdominal, skin, and hydration assessment guided by the history; Assess function against baseline rather than relying on a single normal-looking measurement.

Brief pathophysiology

Volume depletion may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

Shock can be present before profound hypotension. Trend perfusion, mental status, pressure, and pulse characteristics; the direction varies with cause and treatment.

Blood pressure (mmHg)

May fall

Relative change from baseline may be important before absolute hypotension appears.

MAP (mmHg)

May fall

A falling MAP supports impaired perfusion but is not the only endpoint.

Heart rate (bpm)

Often rises

Tachycardia is common; neurogenic, toxic, paced, or medication effects can alter the response.

Pulse pressure (mmHg)

May narrow

Narrow pulse pressure can reflect reduced stroke volume, although distributive states may differ.

Front-load in the triage report

  • Fluid loss, poor intake, vasodilators, or recent dialysis may reduce preload.
  • BP and trend.
  • Baseline if known.
Medication effectCommon presentation pattern

HPI

Clarify baseline if known; poor perfusion; suspected cause: hemorrhage, sepsis, dehydration, cardiac, anaphylaxis.

Signs & symptoms

Fluid loss, poor intake, vasodilators, or recent dialysis may reduce preload.

Focused exam

Assess function against baseline rather than relying on a single normal-looking measurement; Assess bleeding, hydration, infection, cardiac and lung findings, DVT risk, abdominal or pelvic pathology, and medication effects.

Brief pathophysiology

Medication effect may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

Shock can be present before profound hypotension. Trend perfusion, mental status, pressure, and pulse characteristics; the direction varies with cause and treatment.

Blood pressure (mmHg)

May fall

Relative change from baseline may be important before absolute hypotension appears.

MAP (mmHg)

May fall

A falling MAP supports impaired perfusion but is not the only endpoint.

Heart rate (bpm)

Often rises

Tachycardia is common; neurogenic, toxic, paced, or medication effects can alter the response.

Pulse pressure (mmHg)

May narrow

Narrow pulse pressure can reflect reduced stroke volume, although distributive states may differ.

Front-load in the triage report

  • Fluid loss, poor intake, vasodilators, or recent dialysis may reduce preload.
  • Baseline if known.
  • Poor perfusion?
Mimics2 conditions
Measurement errorImportant alternative presentation

HPI

Clarify bp and trend; baseline if known; poor perfusion.

Signs & symptoms

Confirm cuff and trend while assessing actual perfusion.

Focused exam

Perform a targeted cardiorespiratory, neurologic, abdominal, skin, and hydration assessment guided by the history; Assess function against baseline rather than relying on a single normal-looking measurement.

Brief pathophysiology

Measurement error can resemble hypotension / shock through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

Shock can be present before profound hypotension. Trend perfusion, mental status, pressure, and pulse characteristics; the direction varies with cause and treatment.

Blood pressure (mmHg)

May fall

Relative change from baseline may be important before absolute hypotension appears.

MAP (mmHg)

May fall

A falling MAP supports impaired perfusion but is not the only endpoint.

Heart rate (bpm)

Often rises

Tachycardia is common; neurogenic, toxic, paced, or medication effects can alter the response.

Pulse pressure (mmHg)

May narrow

Narrow pulse pressure can reflect reduced stroke volume, although distributive states may differ.

Front-load in the triage report

  • Confirm cuff and trend while assessing actual perfusion.
  • BP and trend.
  • Baseline if known.
Low baselineImportant alternative presentation

HPI

Clarify baseline if known; poor perfusion; suspected cause: hemorrhage, sepsis, dehydration, cardiac, anaphylaxis.

Signs & symptoms

Confirm cuff and trend while assessing actual perfusion.

Focused exam

Assess function against baseline rather than relying on a single normal-looking measurement; Assess bleeding, hydration, infection, cardiac and lung findings, DVT risk, abdominal or pelvic pathology, and medication effects.

Brief pathophysiology

Low baseline can resemble hypotension / shock through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

Shock can be present before profound hypotension. Trend perfusion, mental status, pressure, and pulse characteristics; the direction varies with cause and treatment.

Blood pressure (mmHg)

May fall

Relative change from baseline may be important before absolute hypotension appears.

MAP (mmHg)

May fall

A falling MAP supports impaired perfusion but is not the only endpoint.

Heart rate (bpm)

Often rises

Tachycardia is common; neurogenic, toxic, paced, or medication effects can alter the response.

Pulse pressure (mmHg)

May narrow

Narrow pulse pressure can reflect reduced stroke volume, although distributive states may differ.

Front-load in the triage report

  • Confirm cuff and trend while assessing actual perfusion.
  • Baseline if known.
  • Poor perfusion?
Red flags

Findings that should escalate concern

  • Altered mentation, cool or mottled skin, weak pulses, chest pain, dyspnea, hemorrhage, fever, or persistent low pressure indicates shock until assessed.
  • Hemorrhagic, septic, cardiogenic, or obstructive shock: Poor perfusion plus cause-specific findings requires rapid treatment.
Related EMS presentations

Continue the clinical pathway

CardiacSyncope / presyncopeInfectiousFever / suspected infection / sepsisGIGI bleedCardiacCHF / acute pulmonary edemaAllergic/ImmunologicAllergic reaction / anaphylaxisTraumaAbdominal trauma
References

Clinical and academic sources

Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.

BCEHS Handbook — specific CPGs

  1. D01: ShockBC Emergency Health Services Handbook

    Official BCEHS clinical practice guidance for shock.

Supporting clinical and academic evidence

  1. CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians

    Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.

  2. WHO Medical Emergency ChecklistWorld Health Organization

    A structured emergency assessment framework intended to reduce missed life-threatening conditions.

  3. Circulatory shock in adults in the emergency departmentTurkish Journal of Emergency Medicine · 2023

    Shock classification, perfusion assessment, serial hemodynamics, and cause-directed emergency management.