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What is considered normotensive when providing a bolus?

Question #24

When giving a bolus for hypotension what is considered "normotensive" or a systolic blood pressure that is considered acceptable to terminate the bolus. Of course assuming the pt is not symptomatic and no fluid overload.

Answer:

When administering a fluid bolus for hypotension, the ALS-PCS guidelines consider a patient normotensive when the systolic blood pressure (SBP) exceeds 100 mmHg, provided the patient is asymptomatic and shows no signs of fluid overload.

In certain clinical situations, however, targeting the Mean Arterial Pressure (MAP) may be more appropriate. MAP reflects the average arterial pressure over a cardiac cycle and serves as a better indicator of overall tissue perfusion. In settings such as trauma, significant hypotension, septic shock, or other conditions where ensuring adequate organ perfusion is critical, a target MAP of at least 65 mmHg is often used. It’s also worth noting that most cardiac monitors readily display MAP, making it an accessible parameter during patient management.

In summary:

General target: SBP >100 mmHg
Alternate target in select cases (e.g., trauma, significant hypotension, septic shock): MAP ≥65 mmHg

MABP1      MABP2  

 

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Medical Directive Category

Intravenous Access

Published

15 February 2025

ALSPCS Version

5.4

Views

19

Please reference the MOST RECENT ALS PCS for updates and changes to these directives.