and this is probably somebody who is probably going to get everything scanned.  A hypotensive patient requires a diligent search for ongoing, for occult and ongoing hemorrhage.  Do they have pelvic ___?  Do they have enough long bone ___?  You can lose a liter ____.  Do they have a solid _____ injury where they are losing blood?  And then, if you don’t find ongoing blood loss, then you have to think about other causes for hypotension, especially in the elderly.  Are they having an MI?  Have you gotten that cardiogram yet that you thought about with the initial C for circulation? Why did they fall?  Where is their monitor or their rhythm strip?  Now might be a good time, and ____.  And the last, another cause for hypotension, ______, especially with ______.  ___a cocktail of medication? _______.  Or could this be an occult suicide attempt?  ________ we’ve had some. So you are thinking search for ongoing causes of hypotension, somebody who is persistently hypotensive, if you’ve excluded ongoing hemorrhage, we really need to ______ going back ________ their initial primary survey.  That is all I was prepared to talk to you about, and at least the better part of an hour.  So, I guess, you want to give them a break?  Does anybody have any questions for my about my approach to initial resuscitation?  Essentially, you can sum it up, and you do a good primary survey, and a standard primary survey, in order to prevent hypoxemia and hypotension and secondary brain injury.  That’s it.