•What are the rest of his vital signs?•What is his usual BP?•How does he feel? Was this found on

routine vital sign check or is something wrong?

• Cardiac: –Tachyarythmia –Bradycardia –MI• Physiologic: –ESLD, CHF –Young and asleep• Sepsis• Meds• Hypovolemia: –Dehydration –Bleeding

•See the patient•Call your resident; Call MICU•Recheck vital signs, check

orthostatics•IV Fluids•Get Access•Consider EKG, CBC, T&S, Broad

spectrum ABx

•What are her vital signs?•How do her lungs sound?•What are her IV Fluids?

•Reactive Airway Disease/COPD•PE•Cardiogenic –MI, CHF•Too much IV Fluid•Pneumonia•PTX•Anxiety

•Examine patient –listen to lungs, JVP, LE Edema

•CXR•EKG; cardiac enzymes•ABG•I/Os•On DVT prophylaxis?

•Oxygen•Diurese•Chest CT r/o PE•Nebulizer/BIPAP•Head of bed up•Nitro•Call resident

•What are his vital signs (check both arms)?

•How does he look?•When did it start?•Get an EKG

•MI/aortic dissection•GERD•PE•Anxiety•MSK•Pneumonia; cholecystitis; pancreatitis•Pericarditis

•Evaluate patient•Treat as angina-tele, ASA, B-blocker, nitro,

serial CKs, heparin, tell resident•Treat as GERD-mylanta•Treat as MSK-ibuprofen•Treat as anxiety-reassure; ativan?•Treat as PE –chest CT, heparin?, oxygen Treat as dissection – CT chest, control BP