[Boston-RN]

Originally Posted by NancyNurse08

What was her MAP? Did you look back in the charting to see if her BP had been that low before, if she had received her metoprolol, and what happened?

She didn't have invasive monitoring for me to determine her MAP. This was her lowest BP (her previous low was mid-70's) at SBP of 60 she was assymptomatic. I did not give the lopressor. The MD and NP finally agreed to not give the lopressor. I did not feel comfortable giving lopressor to a pt with and SBP of 60 and having 3 other pts to be responsible for at the same time. If they wanted her to get it so bad they could have transferred her to the unit with lower ratio so she could be monitored more closely.

The patient was transferred to rehab after that shift and signed to refuse further cardiac monitoring because she was peeved we were checking her vitals so often. And yes she is a 55 y.o. w/ mets and a full code.

The original point of my posting was to see if anyone had past experience with the approach of lopressor with a HR in the 120-130 range helped the HR without bottoming a pt's SBP when their SBP was low.

[NancyNurse08]

MAP is a simple mathematical calculation. You do not need invasive monitoring to determine MAP, simply the BP. It was a dumb question, though because in order to have a MAP of 60, her BP would have had to have been 60/60.

A patient with a BP of 85/65 would have a MAP of 65, so even though the patient is hypotensive, they are still maintaining adequate end organ perfusion. If they are asymptomatic and a fluid bolus is contraindicated (ie CHF), then this person might be allowed to "live" in this range.

I would have been uncomfortable giving metoprolol to a patient with an SBP of 60 too, but when thrown into situations like that, I tend to ask questions and look at more data than just one number.

[cardiacRN2006]

Yes, I've given metoprolol IV with a low systolic and high HR. Their BP may be low R/T the low CO from the high HR.

In one specific instance, I gave cardizem a few times, then adenosine twice, then finally metoprolol 5mg IV, and it wasn't until the metoprolol that the HR went down and the BP came up.

[Boston-RN]

Originally Posted by NancyNurse08

MAP is a simple mathematical calculation. You do not need invasive monitoring to determine MAP, simply the BP.

AH I did not know that. I'll have to look it up. I've been told that under SBP of 80ish that's the relative cut off for good organ perfusion. It's nice to know there's a way to calculate it. That's why I was a little surprised that at SBP of 60 this pt was alert oriented and talking on the phone sitting up in a chair.

This is such a good place for info / experience. Thanks