How do you approach caring for patients admitted with decompensated CHF, but who also exhibit hypotension and do not have overt signs of hypervolemia on exam?

For example, do you consider "cautious" IV fluids or otherwise consider early vasopressors?

Answer from: at Academic Institution

Always attempt to stabilize the shock state first, so early vasopressor use may be the only first option if the patient is truly hypotensive - maintenance of perfusion is key. Once the patient is stable, you can then ascertain the volume status with bedside POCUS, such as evaluation of IVC and EF (...

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How do you approach caring for patients admitted with decompensated CHF, but who also exhibit hypotension and do not have overt signs of hypervolemia on exam?

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