Hypotensive Pregnant Pt

[Nate]

A GI bleed. I had a patient that was 20 some odd weeks and had a GI bleed, she almost didn't make it.

[als_medic_uk]

If there was a life threatening GI haemorrhage then blood would be present in faeces or via vomit, the patient didn't complain of abdominal quadrant pain or oesophagus pain did she?

[Nate]

If there was a life threatening GI haemorrhage then blood would be present in faeces or via vomit, the patient didn't complain of abdominal quadrant pain or oesophagus pain did she?

He didn't say, and the other options were taken, so I was just throwing out another cause of hypotension. She hadn't vomited yet, guess we gotta send him in for a stool sample to check and see.

[NCFD18]

90 systolic isn't all that bad if pt tolerates it. The same with the tachycardia. If a pt tolerates those things it might be normal for them so its not of our concern. Also is this orthostatic hypotension?

[canuckEMT]

I would be interested as VS was in the age and gravida/para of the Pt as well.

My wife had those same s/s when she was carrying our 3rd and 4th children, there was no complications and the GP said this was totally normal.

[mizzoumedic74]

90 systolic isn't all that bad if pt tolerates it. The same with the tachycardia. If a pt tolerates those things it might be normal for them so its not of our concern. Also is this orthostatic hypotension?

Orthostatic hypotension happens usually if the pt has fluctuations when she changes position; i.e. from laying to sitting, sitting to standing.

This entire situation sounds more cardiac related than anything else. Remember, the physiology of pregnancy means that cardiac output as well as blood volume are increasing. The pt's body must adapt to the changes. I agree that a 12 lead needs to be done to rule out cardiac.

[NCFD18]

Orthostatic hypotension happens usually if the pt has fluctuations when she changes position; i.e. from laying to sitting, sitting to standing.

No that is orthostatic hypotension is not what happens when you have it.

If its Orthostatic it can be a more accurate sign of:

-Cardiogenic

-Low blood volume (e.g. anemia, dehydration, dialysis)

-Medication related (usually too high doses of blood pressure medications or medications for depression)

-adrenal insufficiency

-Or Neurogenic orthostatic hypotension

[Dustdevil]

I think my head is going to explode.

Somebody please save me. :?

[Ridryder 911]

Ditto... I thought it was just me !

R/R 911

[kevkei]

Question, what is it that a blood pressure of 90/58 makes a person hypotensive? Unless you have a trending of baseline vitals over a period of time prior to conception, you have no idea what her normotensive pressure is so you assume that she is hypotensive.