Low Blood Pressure: A Typical Night in the ER (cont.)
Two liters of fluid have been run in; 4.4 pounds - the same amount as a large bottle of soda. The blood pressure refuses to move higher, and more needs to be done. You're not supposed to treat a number, since the clinical picture is more important than getting the patient to look good on paper. Still, a systolic blood pressure of 70 is too low and it may mean that the organs in the body are lacking sufficient blood flow and oxygen to maintain aerobic metabolism. If he goes anaerobic (lack of oxygen) for a prolonged period of time, then the acid-base balance in the blood stream will cause everything to spiral downhill and the battle will be lost.
Norepinephrine bitartrate (Levophed) is a drug that acts like adrenaline on the body, and will cause the blood vessels to constrict or narrow, to support the blood pressure is started intravenously. It will also put a strain on his heart, not necessarily something we want to do since he has had heart problems, but there isn't much choice.
More fluids... more oxygen...more time. The blood pressure creeps up to the mid-80s...success? He's more alert, and the catheter that was placed in his bladder is starting to show signs of urine. That means his kidneys are receiving enough blood supply to produce urine, and they are sensing that there is starting to be enough fluid in the body to allow that to happen.
The intensive care team has shown up at the bedside. He will be theirs in ICU, and it's time to start transitioning responsibility to them. His systolic blood pressure is 90 now, and the heart rate is down to 100. Things are looking up, but who knows for how long. He's older, undergoing a lot of stress, and still needs machines to help him breathe and medications to support his blood pressure. But he's alive when he leaves the ER; another win.
The next ambulance call comes in.
REFERENCE: Tintinalli J, etal. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th edition. McGraw-Hill Professional 2010
Last Editorial Review: 4/5/2012
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