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Rapid Response

Rapid Response. Hypotension. Called for Hypotension. 71 year old male status post open appendectomy 14 hrs ago. To the bedside. Rapid initial assessment. ABCs Necessary equipment and resources Is immediate intervention required?. Treat the patient. Confirm the Accuracy of the number

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Rapid Response

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  1. Rapid Response Hypotension

  2. Called for Hypotension • 71 year old male status post open appendectomy 14 hrs ago

  3. To the bedside

  4. Rapid initial assessment • ABCs • Necessary equipment and resources • Is immediate intervention required?

  5. Treat the patient • Confirm the Accuracy of the number • Determine Baseline • Symptomatic vs Asymptomatic

  6. Subjective Data • Chart • Meds • Nurse • Family

  7. PMHx • HTN (poorly controlled) • DM II • OA • Obesity • Cholecystectomy • Ankle Surgery 2009

  8. Medications • Home: • Lisinopril • Norvasc • Metoprolol • Glyburide • Tylenol PRN • Alleve PRN

  9. Hospital Medications • Ancef • Subcutaneous Heparin • Protonix • IV Morphine PRN • D5 ½ NS w/ 20meq KCL at 85cc/hr

  10. Objective Data • Volume Status • mentation, mucosa, neck veins, lungs, heart, abdomen, extremities • Labs/Images • I&O

  11. Pre-op labs • WBC – 18, H&H 14/39, Plt – 200 • Na 142, K 4, Cl 95, HCO3 20, BUN 40, Creat 1.3(0.9 2 yrs ago), gluc 110 • Coags WNL

  12. OR Course • Open Appendectomy • OR time 2 hrs • U.O. 85 cc • EBL 150 cc • Lowest SBP low 80s briefly • Received 1.3L crystalloid

  13. Differential Diagnosis • Septic Shock • Cardiogenic Shock • Hypovolemic Shock • Hemorrhagic Shock • Adrenal Insufficiency • Medication Effect • Artifact

  14. Bedside Treatment

  15. Treatment • Fluids, Fluids, Fluids • Check a hemoglobin! • Central Venous Access may be necessary

  16. Summary • ABCs • Equipment • ACLS if needed • Rule out artifact • Fill the tank! • Stabilization before transportation

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