emti2008 Posted April 16, 2009 Posted April 16, 2009 Ok so I have my EMT-I, and I have a question about hypotension. First, when is a BP reading in a normal, healthy adult considered to be hypotensive. I've looked back in my book and it says that a normal systolic BP is 90-140 systolic, but it does not say what the normal Diastolic BP is. Second, if you have a 23 y/o female Pt. taking a Ca channel blocker, c/o dizzyness and is slightly lathargic and the BP reading is consistently 99/58 to 99/68 (taken q5min), is it considered hypotension, and what would be the definitive treatment. Please help me with this, and if you have any questions or need me to explain it better let me know.
JPINFV Posted April 16, 2009 Posted April 16, 2009 (edited) Why is the patient on calcium channel blockers? Edited April 16, 2009 by JPINFV
emti2008 Posted April 16, 2009 Author Posted April 16, 2009 Why is the patient on calcium channel blockers? Hx of Angina, HTN, and Palpitations
rock_shoes Posted April 16, 2009 Posted April 16, 2009 (edited) Hx of Angina, HTN, and Palpitations Those are pretty normal BP readings for a 23 y/o female. Maybe slightly on the hypotensive side but not really. What range does this patients BP normally reside in? It's all relative. If your BP is usually 150/100 you will most likely feel light headed if your BP dips to 110/65. That's a pretty rough history for a 23 y/o. Congenital I'm guessing? Edited April 16, 2009 by rock_shoes
emti2008 Posted April 16, 2009 Author Posted April 16, 2009 (edited) Those are pretty normal BP readings for a 23 y/o female. Maybe slightly on the hypotensive side but not really. What range does this patients BP normally reside in? It's all relative. If your BP is usually 150/100 you will most likely feel light headed if your BP dips to 110/65. That's a pretty rough history for a 23 y/o. Congenital I'm guessing? Umm, the normal BP is high (160/100-140/92), which is the first reason Pt. was put on medication, but medication is also used in treatment of Hx of Angina and Palpitations. and only 5 years of Hx, no problems before. How low would the #'s need to be to be concerned that it is a problem that needs to be fixed. Edited April 16, 2009 by emti2008
rock_shoes Posted April 16, 2009 Posted April 16, 2009 Umm, the normal BP is high (160/100-140/92), which is the first reason Pt. was put on medication, but medication is also used in treatment of Hx of Angina and Palpitations. and only 5 years of Hx, no problems before. How low would the #'s need to be to be concerned that it is a problem that needs to be fixed. Is that the patients normal BP while on her medications or is that her un-medicated BP? It's possible that her BP was reduced too quickly by her medications thus the symptoms. Anti-hypertensives are normally titrated to desired effect to avoid these kind of circumstances. If the patient is alert and oriented with adequate perfusion, BP over 90 systolic, in NSR, there really isn't anything to be done pre-hospitally for her. She does need to be transported to a hospital where they can review her medication situation and adjust dosages however. If a patients BP where less than 90 systolic due to volume loss (trauma) a fluid bolus of NS may be advisable to maintain a perfusion head. If the decrease in BP is due to a medical cause treatment plans can vary a great deal more. If it's cardiac in nature it will be done as per ACLS guidelines. If it's due to say anaphylaxis a single fluid bolus of 500mL NS can do wonders to maintain perfusion in counteracting some of the effects of fluid shift.
DartmouthDave Posted April 16, 2009 Posted April 16, 2009 Hello, An other option is the MAP. Most NIBP cuffs will calculate this for you. In general a MAP should be 60 or greater. However, like noted above, the key is how the patient looks and feels and how this BP (SBP and DBP) compares to the normal if available. D
FireMedic65 Posted April 16, 2009 Posted April 16, 2009 treat the patient and their symptoms. use the diagnostics as a tool to assist you in your treatment. If you patient is showing such vital signs and acting normal, think about why it is like that. ask them if it is normal for them. My friend is the same age as me, and roughly the same height and weight. My normal vitals signs are around a HR of 52, BP 102/78 RR 12. Where as his, are HR in the 80/90s, BP 140/90, RR 18. Both of them are normal for ourselves. If I call 911 for an issue, and you read those vitals for me, don't treat me for hypotension or bradycardia, because they are normal for me. Treat ME, the patient.
Ridryder 911 Posted April 16, 2009 Posted April 16, 2009 We treat patients NOT numbers. As the previous posts described. Not all mid 20 year old as well may have a lower blood pressure all dependent upon the make-up of their body. Realistically, and truthfully you will NOT know what their ideal blood pressure or even what a normal BP is unless you perform serial readings. Even then one has to be sure to take them about or near the same time of the day, activity, same arm and position. One of my pit pees is to hear v.s. WNL. Really, you know what their normal limits are? Nope. R/r 911
tskstorm Posted April 16, 2009 Posted April 16, 2009 One of my pit pees is to hear v.s. WNL. Really, you know what their normal limits are? Nope. R/r 911 Around here, WNL stands for "We Never Looked"
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