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Rapid Response. Hypotension. Called for Hypotension. 71 year old male status post open appendectomy 14 hrs ago. To the bedside. Rapid initial assessment. ABCs Necessary equipment and resources Is immediate intervention required?. Treat the patient. Confirm the Accuracy of the number
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Rapid Response Hypotension
Called for Hypotension • 71 year old male status post open appendectomy 14 hrs ago
Rapid initial assessment • ABCs • Necessary equipment and resources • Is immediate intervention required?
Treat the patient • Confirm the Accuracy of the number • Determine Baseline • Symptomatic vs Asymptomatic
Subjective Data • Chart • Meds • Nurse • Family
PMHx • HTN (poorly controlled) • DM II • OA • Obesity • Cholecystectomy • Ankle Surgery 2009
Medications • Home: • Lisinopril • Norvasc • Metoprolol • Glyburide • Tylenol PRN • Alleve PRN
Hospital Medications • Ancef • Subcutaneous Heparin • Protonix • IV Morphine PRN • D5 ½ NS w/ 20meq KCL at 85cc/hr
Objective Data • Volume Status • mentation, mucosa, neck veins, lungs, heart, abdomen, extremities • Labs/Images • I&O
Pre-op labs • WBC – 18, H&H 14/39, Plt – 200 • Na 142, K 4, Cl 95, HCO3 20, BUN 40, Creat 1.3(0.9 2 yrs ago), gluc 110 • Coags WNL
OR Course • Open Appendectomy • OR time 2 hrs • U.O. 85 cc • EBL 150 cc • Lowest SBP low 80s briefly • Received 1.3L crystalloid
Differential Diagnosis • Septic Shock • Cardiogenic Shock • Hypovolemic Shock • Hemorrhagic Shock • Adrenal Insufficiency • Medication Effect • Artifact
Treatment • Fluids, Fluids, Fluids • Check a hemoglobin! • Central Venous Access may be necessary
Summary • ABCs • Equipment • ACLS if needed • Rule out artifact • Fill the tank! • Stabilization before transportation