A Typical Night in the ER
Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
The ambulance call comes in.
"We're running lights and siren with a 67 year old male. He's confused, lethargic, blood pressure 80 over 40, thready pulse (a pulse that is very fine and barely perceptible) and sweaty. We'll be at your door in a couple of minutes."
The nurses start setting up the equipment to care for the patient. We've been through this drill before when someone arrives at the ER with low blood pressure. I hope it's an easy diagnosis and something that we can treat quickly. IV's are set up, monitor pads ready. The respiratory tech arrives with her machines just in case they are needed.
The EMTS unload a man in obvious distress, sweaty, struggling to breathe, and limp.
"He's had a fever for a couple of days with a cough. Past history of COPD, heart problems, and smokes."
The diagnosis could be easy, but there are a variety of factors that could be causing this man's condition. He is in shock; his blood pressure is so low there is not enough pressure to provide blood flow and oxygen to his brain. That's why he is lethargic. No doubt the rest of his organs are at risk too. But why?