Hypotension at 2 AM: 5 Mistakes Residents Make on Call

What do you do when your pager goes off at 2 AM, and the blood pressure is 82/55? In this video, I break down the most common mistakes residents and hospital clinicians make when responding to hypotension overnight — including when NOT to reflexively give fluids, how to assess whether the patient is truly unstable, and when low blood pressure requires ICU-level escalation. We’ll cover: How to approach hypotension at night The “Stabilize → Recognize → Treat” framework When a low BP is actually dangerous Common fluid bolus mistakes Hypotension in heart failure and ESRD patients How to recognize shock early When to call rapid response or transfer to ICU Vasopressors, sepsis, bleeding, and medication-related hypotension This is practical 2 AM medicine for residents, hospitalists, interns, NPs, PAs, and anyone taking overnight call. Topics covered: hypotension management, low blood pressure, shock, ICU medicine, hospital medicine, internal medicine, rapid response, sepsis, vasopressors, fluid resuscitation, overnight admissions, residency survival, ICU rotation, hospitalist tips, on-call medicine Subscribe for more real-world Internal Medicine and ICU teaching. #InternalMedicine #HospitalMedicine #ICU #Hypotension #residency 🔔 Sign up for video summaries on Substack using this link: https://substack.com/@rahamneh?utm_so... 🔔 For tutoring and training sessions, please send me an email at [email protected] 🔔 My ebook "Inpatient diabetes management": https://rahamneh.gumroad.com/l/Inpati... 🔔 My ebook "Antibiotics in Clinical Practice": https://rahamneh.gumroad.com/l/jmorlb 00:00 - The 2 AM Pager: BP 82/55 Initial Response 00:25 - Clinical Framework: Stabilize, Recognize, Treat 00:41 - Hypotension Management: Don't Treat Just the Number 01:32 - Assessing Vital Sign Trends in Stable Patients 03:21 - Fluid Resuscitation Mistakes: Bolus vs. Drip 05:01 - Determining the Mechanism of Shock 05:53 - When to Escalate: ICU Transfer vs. Floor Monitoring 06:46 - Summary: Building Clinical Confidence on Call