An important message regarding the current COVID-19 pandemic. Click here to read more.


Under Pressure


A patient comes to the ER with hypotension, and the cause is unknown. Can you narrow down the diagnosis, while treating the acute condition?

  1. Detailed Examination in Suspected Opioid Overdose
  2. Diagnosing and Treating Suspected Opioid Overdose
  3. Drugs that can cause Hypotension
  4. Evaluation of a Hypotensive Patient
  5. Lisinopril Overdose
  6. Psychiatric Consultation in the ER
  7. Suicide Screening in the Emergency Department
  1. ALHUTHAIL YR. Timing of Referral to Consultation-Liaison Psychiatry Int J Health Sci (Qassim) [online] 2009/07/01 00:00, 3(2):175-170 [viewed 22 December 2015] Available from:
  2. BARR CS, PAYNE R, NEWTON RW. Profound prolonged hypotension following captopril overdose. Postgrad Med J [online] 1991/10/01 00:00, 67(792):953-954 [viewed 22 December 2015] Available from:
  3. BOYER EW. Management of Opioid Analgesic Overdose N Engl J Med [online] 2012/07/12 00:00, 367(2):146-155 [viewed 19 December 2015] Available from: doi:10.1056/NEJMra1202561
  4. BRONHEIM HE, FULOP G, KUNKEL EJ, MUSKIN PR, SCHINDLER BA, YATES WR, SHAW R, STEINER H, STERN TA, STOUDEMIRE A. The Academy of Psychosomatic Medicine practice guidelines for psychiatric consultation in the general medical setting. The Academy of Psychosomatic Medicine. Psychosomatics [online] 1998 Jul-Aug, 39(4):S8-30 [viewed 22 December 2015] Available from:
  5. BROOKS MJ. Mitigating the safety risks of drugs with a focus on opioids: are risk evaluation and mitigation strategies the answer? Mayo Clin Proc [online] 2014 Dec, 89(12):1673-84 [viewed 21 December 2015] Available from: doi:10.1016/j.mayocp.2014.09.003
  6. JONES AE, YIANNIBAS V, JOHNSON C, KLINE JA. Emergency department hypotension predicts sudden unexpected in-hospital mortality: a prospective cohort study. Chest [online] 2006 Oct, 130(4):941-6 [viewed 22 December 2015] Available from: doi:10.1378/chest.130.4.941
  7. LOKKO HN, STERN TA. Collaboration and Referral Between Internal Medicine and Psychiatry Prim Care Companion CNS Disord [online] 1/01/01 00:00, 17(1):10.4088/PCC.14f01746 [viewed 22 December 2015] Available from: doi:10.4088/PCC.14f01746
  8. LOW PA, TOMALIA VA. Orthostatic Hypotension: Mechanisms, Causes, Management J Clin Neurol [online] 2015/07/01 00:00, 11(3):220-226 [viewed 22 December 2015] Available from: doi:10.3988/jcn.2015.11.3.220
  9. MCGEE S, ABERNETHY WB 3RD, SIMEL DL. The rational clinical examination. Is this patient hypovolemic? JAMA [online] 1999 Mar 17, 281(11):1022-9 [viewed 22 December 2015] Available from:
  10. RAMIREZ J. Severe hypotension associated with α blocker tamsulosin. BMJ [online] 2013 Nov 5:f6492 [viewed 22 December 2015] Available from:
  11. SCHWEMMER M, BASSENGE E, STOETER M, HARTMANN B, HESS U, FINK B. Potentiation of sildenafil-induced hypotension is minimal with nitrates generating a radical intermediate. J Cardiovasc Pharmacol [online] 2001 Jul, 38(1):149-55 [viewed 22 December 2015] Available from:
  12. SHOEMAKER WC, HOPKINS JA. Clinical aspects of resuscitation with and without an algorithm: relative importance of various decisions. Crit Care Med [online] 1983 Aug, 11(8):630-9 [viewed 22 December 2015] Available from:
  13. SRIVASTAVA K, SACHER VY, NELSON CT, LEW JI. Multifactorial Model and Treatment Approaches of Refractory Hypotension in a Patient Who Took an ACE Inhibitor the Day of Surgery Case Rep Anesthesiol [online] 2013/01/01 00:00:723815 [viewed 22 December 2015] Available from: doi:10.1155/2013/723815
  14. WERMELING DP. Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access. Ther Adv Drug Saf [online] 2015 Feb, 6(1):20-31 [viewed 21 December 2015] Available from: doi:10.1177/2042098614564776