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Low Blood Pressure A Typical Night in the ER (cont.)

Emergency Treatment Begins

The nurses are already in motion, and two IVs have been placed. Fluid is being pumped in. Lab tests and a chest X-ray have been ordered.

No time to wait for test results. The patient needs help now. The respiratory tech sets up a BiPAP machine to help support his breathing. It pushes air into the mouth and lungs to try to force air into the lungs. Medication is added to relieve the wheezing. There is a downside to BiPAP. It can lower the blood pressure for a while as the body gets used to it, but the alternative is to intubate this patient and put him on a ventilator.

The patient has a history of smoking and COPD; putting him on a ventilator increases his mortality (risk of death) significantly. He has to hold on, so that the medical procedures and tests we are doing can reverse his illness and to raise his blood pressure.

The chest X-ray confirms the diagnosis of pneumonia. Say goodbye to the diagnosis of pulmonary embolism. Antibiotics are given. The intravenous fluid infusion hasn't increased the blood pressure yet, but it's still early. He's tolerating the BiPAP machine, not an easy feat, since it feels like sticking your head outside a car window as you go down the road at 50mph.

The good news is that he's waking up a little bit. While the blood pressure is low, perhaps the fluid is allowing more oxygen delivery to the brain.

Medically Reviewed by a Doctor on 4/18/2017

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