Medical Direction and Practices Board WHITE PAPER Use of Pressors in Pre-Hospital Medicine: Proper Indication and State of the Science Regarding Proper Choice of Pressor

The key to “best practice” rests in understanding that low blood pressure is merely one manifestation of poor perfusion, but it is not the sole finding in shock. Some patients are in shock, despite what appears to be normal blood pressure. Children and young adults are classic examples of patients who do not initially drop their blood pressure when they first fall into shock. Hypotension in adults is defined as a systolic blood pressure less than 90mm Hg. But it is also defined as a systolic blood pressure more than 30 mm Hg below a patient’s baseline. Because a patient’s baseline is often unknown, EMS providers must rely on other findings that define poor perfusion. For example, cool hands and feet are a result of poor perfusion to the extremities. Subtle altered mental status is a result of poor perfusion to the brain. Chest discomfort and shortness of breath are the result of poor perfusion to the heart and lungs.