Virtual Morning Report - June 9, 2026 - Cough + Hypotension

Cough/SOB + Hypotension: 2 systems at play Use Cough/SOB as a starting place to investigate respiratory system. Is the hypotension a result, or separate problem? Hypotension: Is this Sepsis? Addressing objective data early. Assessing for signs of sepsis (high mortality cause of hypotension) SHOC: Sepsis, Hemorrhagic, Obstructive, Cardiac Acute on Subacute: Constitutional symptoms (syncope, night sweats, chills) with an acute CV insult (SOB, hypoxia, hypotension) Localizing the problem: Chest v Blood Is this a structural issue in the chest (lung abscess) versus a substance in the blood (systemic infection, inflammation) Don’t anchor initially on mold/tick exposures, think broadly. Night Sweats: Think smoldering infections (TB, abscess, osteo) or malignancy Lung negative SOB: Points toward the blood (normal auscultation and XR) Scleral icterus: Already on exam hinting towards a hemolysis or biliary issue. Scleral icterus -> limb jaundice Transaminitis + Thrombocytopenia: Pattern association of objective data for tick borne illness. Evaluate sequence of exposure and symptom evolution. Thrombocytopenia + Splenomegaly: Activated Reticuloendothelial system ⁃ Tick + atypical zoonotic, lepto, parasites, malaria, viral, granulomatous disease, etc. (bacteria > viral given neutrophil activation)