Low Blood Pressure Calls
Know when low BP is dangerous — symptoms over numbers, medication causes, and safe routing.
Learning Objectives
- 1.Recognize when low blood pressure is dangerous.
- 2.Identify medication and volume causes of hypotension.
- 3.Route low-BP calls by symptoms.
Purpose
A low number matters far less than how the patient feels. Symptomatic hypotension — lightheaded, near-fainting, confused — can signal something serious. Treat symptoms, not just the reading.
What to ask
- •The reading, and symptoms: lightheaded, near-fainting, weak, confused, cold/clammy?
- •Worse standing up (orthostatic)?
- •New/increased BP meds or diuretics? Over-diuresis?
- •Dehydration: poor intake, vomiting, diarrhea?
- •Chest pain, shortness of breath, or fainting?
Red flags — escalate
- •Symptomatic hypotension: near-syncope, confusion, cold/clammy, very weak.
- •Low BP with chest pain or shortness of breath.
- •Signs of poor perfusion / looks very unwell.
- •Fainting episode.
Escalate
Symptomatic low BP (especially with confusion, chest pain, or near-syncope) → 911/ED and notify the provider. An asymptomatic low-ish reading in someone who feels fine is lower risk — route and review meds.
Common causes to note
- •Over-medication (BP meds/diuretics), dehydration, over-diuresis, new med additions.
What to send the provider
- •Reading, symptoms, orthostatic change, recent med changes, intake/volume status, urgency read.
Patient education script
- •"Stand up slowly. Sit or lie down if you feel faint." / "If you feel very weak, confused, or have chest pain with this, call 911."
Spanish phrase
Do you feel dizzy or like you might faint when you stand up?
¿Se siente mareado o como que se va a desmayar cuando se pone de pie?
seh SYEN-teh mah-reh-AH-doh oh KOH-moh keh seh vah ah des-mah-YAR KWAN-doh seh POH-neh deh PYEH
Mini case
A patient on a new diuretic reports BP 84/52, feels very dizzy, near-fainting when standing, and hasn’t been drinking much.
What now?
Show answer
Symptomatic hypotension with near-syncope and likely volume depletion/over-diuresis — escalate (911/ED if near-fainting/confused), notify the provider, and don’t adjust meds yourself. The symptoms, not just the number, drive this.
Checklist
- Focused on symptoms, not just the number.
- Checked orthostatic change and recent med additions.
- Screened for chest pain/confusion/near-syncope.
- Escalated symptomatic hypotension.