Concerns about a recent call

[n5iln]

Not confused about the fact that her B/p would drop after taking NTG. It just sounded like that when it wore off, it actually made her hypertensive afterwards. The NTG would explain the low B/P the first time around, but what I'm really curious as to why she shot up in to the 150 range, and then lowered again by the time we got to the hospital, without more administration of NTG. Maybe she was just that anxious, but she was keeping it inside...no idea. Thanks again.

I've seen rebound hypertension after NTG wears off...it can be that profound. It also doesn't seem to last very long, so I don't normally panic about it unless the patient is symptomatic.

I'd be more worried about the BP going back down below 100mmHg systolic afterwards, especially with no more NTG on board. But if the patient's not symptomatic from the comparative hypotension, I won't worry very much about it either.

The bottom line: look at the patient. All the machines spitting out all those numbers don't mean diddly without looking at the patient. Is their baseline BP in the high 90s or low 100s systolic? Often we have no way of knowing unless the patient tells us first, and they may not think it's something to pass on to us unless we start fussing about it. And if we start fussing about it, that just makes the patient anxious, and throws their vitals for a loop.

[Doczilla]

As a learning point here, take note of differing BPs in each arm. This can sometimes be seen in the setting of dissecting thoracic aneurism.

I'm not saying that's what's going on here, it just brought this little pearl to mind.

'zilla

[whit72]

Maybe she s orthostatic? Was it hot out? Was she exerting herself? What was her pulse rate when you noted the falling BP?

It could be anything. I guess.

I am guessing the most likely cause to be the NTG.

[mrmeaner]

I was dispatched to a woman not feeling good (I don't feel good a lot, however, dont call an ambulance for that :roll: ).

That is a common complaint of women during an MI and sometimes it's the only complaint. Probably shouldn't be assumed benign (even if it's the eighth time to the same residence).

What was her estimated weight? Were the B/P's all taken w/ the pt. in the same position (i.e. standing, sitting, lying down) or varied positions? Did she change mental status during the B/P changes? What was her medical history?

[dahlio]

All pulse rates were withing the 75-85 bpm range at all times. All the b/p's were take from the pt. in the semi fowlers position. The only history we were aware of, was of chronic migranes. I didn't think about taking it in the other arm...thanks for the sugg.