1 / 18

RAPID RESPONSE

RAPID RESPONSE. Hypotension. Hypotension. 79 year old female from nursing home admitted with cellulitis. Rapidly Triage. Get to the bedside! Will this patient be dead in … . One minute One hour or One day. Initial Assessment. ABC Stable vs. Unstable Initiate ACLS protocol?

hans
Download Presentation

RAPID RESPONSE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. RAPID RESPONSE Hypotension

  2. Hypotension • 79 year old female from nursing home admitted with cellulitis

  3. Rapidly Triage • Get to the bedside! • Will this patient be dead in…. • One minute • One hour or • One day

  4. Initial Assessment • ABC • Stable vs. Unstable • Initiate ACLS protocol? • Artifact?? • What is the baseline?

  5. Artifact • Manual BP • Check both arms • Palpate Pulses

  6. Artifact

  7. Immediate Interventions • IV Acces • Airway management • ACLS Protocol

  8. Historical Information • Past Medical History • Medications • E.R./Hospital Course

  9. Medications • Prophylactic Lovenox • Coreg • Aspirin • Combivent • Lipitor • MVI • Protonix • Prozac • PRN Percocet • Metformin • SSI

  10. ER/Hospital Course • ER Vital Signs: T 100.7, HR 115, BP106/80, RR 20 SPO2 91% on 2L nc • Pt noted to be pleasant and mildly confused, had an indeterminate troponin. Given Ancef, NS at 85cc/hr. Admitted to telemetry. U.O. past 12 hrs – 200cc

  11. PMHx • CAD s/p RCA stent 2004 • COPD on home O2 • HTN • DM II • Diverticulosis • CEA 2008 • Appendectomy, hysterectomy

  12. Objective Data • Physical Exam • Laboratory Data • Imaging

  13. Laboratory Data • In ER: • WBC – 14, H&H 12/39, PLT – 140 • Na 142, K 4, Cl 105, HCO3 14, BUN 40, Creat 1.5 (1.1 2008), Gluc 175 • Bedside: • EKG inverted Ts inferior leads, No ST changes, S. Tach 135 • PCXR Small lung vol. no obvious infiltrate • Gluc 220

  14. Bedside Workup • Vital Signs • EKG • PCXR • Finger Stick • ABG • Labs (lactate, chemistries, cbc, cortisol, type and screen, cardiac enzymes)

  15. Differential Diagnosis • Cardiogenic Shock • Hypovolemic Shock • Hemorrhagic Shock • Septic Shock • Adrenal Insufficiency • Medication Effects • Artifact

  16. Treatment

  17. Treatment • Fluids, Fluids, Fluids • Crystalloid vs. Colloid vs. Blood Products • Vaspopressors • Steroids • Central line insertion • Transfer to higher level of care

  18. Summary • Initial rapid assessment – ABCs • Equipment – IV, O2, monitor, suction etc.. • Determine need for immediate interventions • Rule out artifact • Restore intravascular volume • Stabilize then transport

More Related