Inclusion Criteria:  Primary Criteria  MAP <65  SBP <90 or BP rapidly trending lower  Secondary Criteria  Low urine output Acute change in urine output less than 50ml/4 hours Persistent hyperlactatemia A new vasopressor started Acute change in HR less than 50 or greater than 120 New onset chest pain or chest pain different then admission assessment Acute bleeding Fever > 39 degrees Significant change in mental status: confusion, agitation, delirium, etc. Unexplained lethargy CRT >2 seconds -  Exclusion Criteria:  Primary diagnosis of: acute cerebral vascular event, acute coronary syndrome, acute pulmonary edema, status asthmatics, major cardiac arrhythmia, drug overdose, or injury from burn or trauma Known aortic insufficiency, or aortic abnormalities Requires immediate surgery Advanced directives restricting implementation of the resuscitation protocol Known intraventricular heart defect, such as VSD or ASD Prisoner Pregnancy Age <18 Known allergy to sensor material or gel Suspected intra-abdominal hypertension Inability to obtain IV access Patient should be excluded based on the opinion of the Clinician/Investigator Patient has an unstable airway