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Troubleshooting review

Hypotension after intubation

Airway-adjacent shock physiology.

Educational review boundary: This page summarizes common patterns and published management options. It does not analyze an individual patient or generate a treatment directive. Verify the current source, local protocol, and clinical context.
Medication / vasodilationInduction, sedation, analgesia.Positive-pressure effectPreload loss, PEEP, high intrathoracic pressure.Tension / auto-PEEPPneumothorax or stacked breaths.RV / underlying shockPE, pulmonary HTN, sepsis, bleeding.

Management considerations

  • Check pulse/rhythm/MAP and EtCO₂ trend.
  • Reduce excessive intrathoracic pressure if appropriate.
  • Treat tension/auto-PEEP/RV failure/hemorrhage/sepsis as indicated.
  • Review induction and sedation medications.

Clinical review / use limits

Authored by: Airway of the Month education team. Last reviewed: July 2026. Audience: EM learners, faculty, EMS, RT, simulation educators, and airway teams.

Resources · Editorial policy · ACEP intubation policy · AARC 2024 ventilator assessment guideline · ATS 2024 ARDS guideline update

About this resource
Created by: Andrew Pirotte, MD; Kyle Brown, MD; Reba Hodge, MD; Amanda Vanderwerf, PharmD, BCEMP; Morgan Kimball, PharmD, BCEMP; Joshua Mohess Clinical review: Emergency medicine faculty review completed. Medication content reviewed by Amanda Vanderwerf, PharmD, BCEMP, and Morgan Kimball, PharmD, BCEMP. Last reviewed: 2026-07-23 Next scheduled review: 2027-01-23 Designed for: EM residents, emergency physicians, EMS clinicians, airway educators, and simulation faculty Important: Educational resource and clinical-reference guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment. Website contact: [email protected]