Hypotension can be a sign of significant underlying pathology, and if it is not rapidly identified and addressed, it can contribute to organ injury. Treatment of hypotension is best targeted at the underlying etiology, although this can be difficult to discern early in a patient's disease course. Expedited bedside evaluation with rapid initiation of treatment based on the most likely underlying etiology is paramount, followed by serial reassessment of the patient's condition. This review synthesizes the key aspects of the presentation and evaluation of a patient with hypotension, including salient historical features, physical examination findings, and diagnostic tests that can help guide treatment.