scubanurse Posted August 8, 2012 Share Posted August 8, 2012 Any recent falls? I'm thinking with the kyphosis the lower ribs could be causing an increase in the thoracic pressure, therefore more pressure placed on heart because the lungs can't fully deflate, decreasing cardiac output and causeing the low BP and S/S? I'm probably way off on this though and just taking a shot in the dark! Link to comment Share on other sites More sharing options...
mobey Posted August 8, 2012 Author Share Posted August 8, 2012 No trauma. As stated, this patient was just sitting there drinking tea. Sudden onset. Link to comment Share on other sites More sharing options...
paramatt_ Posted August 8, 2012 Share Posted August 8, 2012 I agree with fakingpatience and the tamponade but there seems to be something much larger at play. I'd be initating a prompt transport, IV access but no fluid... Link to comment Share on other sites More sharing options...
Kaisu Posted August 8, 2012 Share Posted August 8, 2012 I agree with fakingpatience and the tamponade but there seems to be something much larger at play. I'd be initating a prompt transport, IV access but no fluid... How would you support that BP? OP What is the MAP? Link to comment Share on other sites More sharing options...
mobey Posted August 8, 2012 Author Share Posted August 8, 2012 I'd be initating a prompt transport, IV access but no fluid... Maybe in the urban setting, but here in scenarioland (and my world) we have a 30min rendezvous with a fixed wing airplane, or 3.5hr by ground. I.V is in, bilat. BP 82/58 MAP 54 Resps 22 HR 114 Confused but alert. Still 10/10 pain Link to comment Share on other sites More sharing options...
DartmouthDave Posted August 8, 2012 Share Posted August 8, 2012 (edited) Hello, Are S1 and S2 normal? Muffled heart sounds? New mummur? Stomach soft? Maybe, she repture a cardica valve or repture a cardiac aneurysm? However, I am leaning towrda a repture AAA or a thoracic aneurysm with the sudden onset, lower back pain, and frank hypotension. I would drop in 1L bolus and start to package her for transport. maybe with a better pressure her LOC will imporove. I would also get ready for a tube if need be. Cheers Edited August 8, 2012 by DartmouthDave Link to comment Share on other sites More sharing options...
paramatt_ Posted August 8, 2012 Share Posted August 8, 2012 How would you support that BP? Granted that the MAP has much to be desired, however, I would still be wary about fluid administration. OP stated we have radials…I would be content with this for the time being. Maybe start off with legs elevated as long as it’s tolerated and some 02 via mask if not already done. Anything we can do for the pain/anxiety? Opioids would be out due to the poor perfusion…anything else at your disposal? Link to comment Share on other sites More sharing options...
mobey Posted August 8, 2012 Author Share Posted August 8, 2012 Hello, Are S1 and S2 normal? Muffled heart sounds? New mummur? Stomach soft? Maybe, she repture a cardica valve or repture a cardiac aneurysm? However, I am leaning towrda a repture AAA or a thoracic aneurysm with the sudden onset, lower back pain, and frank hypotension. I would drop in 1L bolus and start to package her for transport. maybe with a better pressure her LOC will imporove. I would also get ready for a tube if need be. Stomach is soft. As I replied to Doc, I don't know enough about heart sounds to give any feedback. 1lt fluid in BP 82/58 MAP62 HR 112 RR 22 Granted that the MAP has much to be desired, however, I would still be wary about fluid administration. OP stated we have radials…I would be content with this for the time being. Maybe start off with legs elevated as long as it’s tolerated and some 02 via mask if not already done. Anything we can do for the pain/anxiety? Opioids would be out due to the poor perfusion…anything else at your disposal? Don't forget a MAP <65 (some will argue 60 but we are not using invasive technology here) means end organs are not being perfused. To withold BP treatment from this patient, is nearly a death sentence. Pain/anxiety, you can have whatever you want. Link to comment Share on other sites More sharing options...
Kaisu Posted August 8, 2012 Share Posted August 8, 2012 I am not even going to worry about pain/anxiety at this point vis a vis medications. I think we are dealing with a major bleed at this point - I would guess a dissecting aorta. Get that rotor on it's way and get that patient to definitive care. The MAP is not ideal and it is symptomatic with confusion. Hi-Flow O2, hoping that will clear the confusion without jacking up the BP and aggravating the bleed. Link to comment Share on other sites More sharing options...
mobey Posted August 8, 2012 Author Share Posted August 8, 2012 I am not even going to worry about pain/anxiety at this point vis a vis medications. I think we are dealing with a major bleed at this point - I would guess a dissecting aorta. Get that rotor on it's way and get that patient to definitive care. The MAP is not ideal and it is symptomatic with confusion. Hi-Flow O2, hoping that will clear the confusion without jacking up the BP and aggravating the bleed. Don't hate me But how do you account for the JVD? Link to comment Share on other sites More sharing options...
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