Intersting article on BP and Shock.

[itku2er]

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[FireMedic65]

Good read Terri, thanks!

[Kiwiology]

Guess this all goes back to the old rhetoric of "treat your patient, not the [numbers/monitor/whatever]"

I remember one old guy with a BP of 80 systolic who was up dancing around and completly haemodynamically stable, me on the other hand last time I got sick I was on the verge of passing out running a pressure of 90 systolic.

Seems that we are (for the better) shifting away from empirical guidelines to those based upon science and valid research. Our guidelines have undergone radical transformation in the last 5 years to reflect the fact it's far better to have a set of options available to you rather than just following a protocol; most of this has been (to my understanding) based upon the evidence coming out in JAMA/JPHC/other studies etc.

One of my good friends started out in the service during the mid seventies; he says common practice back then was to give lots and lots of fluid (so much so he swears patients used to bleed clear!).

[tskstorm]

I have a PDF that goes along with this, if anyone wants to read shoot a PM with an email address.

[Ridryder 911]

One as well need to recognize mean arterial pressure (MAP) to assess the depth of shock in addition to pulse pressure.

R/r 911

[Jeepluv77]

I've actually been wondering what a narrow or wide pulse pressure would mean. I knew it was important, but not why. Now I have at least part of my answer. Thanks for a great read!

[DwayneEMTP]

I just browsed through the article, but it sounds like all he's really saying is, "Don't confuse a patient in compensated shock for a well patient."

Really?

Learning point for those newer to the profession. If the answer is obvious to you, please don't answer.

What s/s/other means would you use to determine that a patient is in compensated shock as opposed to simply being a well patient? Also, please don't quote your books, let's use our heads and walk through the physiology instead...

Dwayne

[rock_shoes]

Nothing earth-shattering or surprising in this article but it's a great reminder to look at all the facts when evaluating a patient. There is good reason that BP is not your only vital sign. In fact it's frequently one of the last to show significant change.

[WelshMedic]

This is indeed not new. A pt with a drop in BP will ultimately already be decompensating to some degree. There are more subtle signs to watch for before this happens: a raised respiratory rate, restlessness, diaphoresis.

This should be the basics but I guess some folk need reminding, so a good article all-round.

WM

[funkytomtom]

Interesting read...its fascinating to go a little more in depth than my emtb class does. Theres so much more to know! Although to my classes credit, we have always been taught to "treat your patient" and not rely on the charts in the book as the word of god...thanks for the post.