CTXMEDIC Posted January 25, 2009 Posted January 25, 2009 One thing I do question is what danger to the patient is there when his bp is so high, he's having an MI and we drop the pressure with meds. What happens to the heart and it's components when we drop the bp? Is it detrimental to the patient to go from 250/173 to 180/100 or 180/90? With an MI we want rate control to reduce the O2 demand of the heart. Do you remember his rate? In your guys case we also want pressure control. Labetalol will do both of these things for us. If we just blast him with a nitro spray, all we're doing is dilating vessels and potentially causing a relfex tachycardia. when it wears off pressure goes back up and we spray it again. this is why the spray or a tablet kinda sucks. you just end up chasing your tail and making your patient feel like sh!t. if we just nitro drip this guy, his rate is going to climb because he then becomes relativley hypotensive. even if you get him down to 200/100 his body is going, wtf? and will kick up the heart rate, which sucks. even on a 60 drop set which is a manageable setup, we're only 'solving' one problem. Again, with Labetalol, we knock off two of this guys problems. you mentioned he was in CHF as well, right? pulm edema?
Just Plain Ruff Posted January 26, 2009 Author Posted January 26, 2009 his rate was around 128 or so I can only speculate the congestion and rhonchii and some wheezes were either chf or pulm edema. I did not have a chest xray because we met the helicopter at the helipad and never made it to the ER
spenac Posted January 26, 2009 Posted January 26, 2009 I actually had a patient have a CVA in the ambulance this week. I was working by protocol trying to lower BP slowly during long transport. 10 minutes to hospital patients voice became very slurred. Right side completely limp. Facial droop. It sucked to take a patient into the ER in worse condition than when I loaded them into it. I've rerun the scenario multiple times and see nothing I could have done different.
diazapam Posted January 26, 2009 Posted January 26, 2009 Sounds like your pt. would have benefited from the NTG/and Morphine from the Rx of his active MI, regarding his B/P sound like a second pertinent positive due to the MI.
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