Hypotension question

Horseshoe, BSN, RN · Mar 20, 2011

A key term here in the OP was "asymptomatic." Patient is now asymptomatic (doesn't mean he will remain so). I would not fluid bolus an asymptomatic patient, particularly without an order, nor would I "run" to call the doctor. I would assess the situation further. For one, I'd get another BP in 15 minutes, I would consider their history, medications, previous trends, etc. I like the idea of dangling at the bedside, see how they feel, etc. I would not just let them get up out of bed without assistance. I would have the second set of vitals and all of my assessments at hand if I decided to call the doctor on this.

silentRN · Mar 20, 2011

Not every hypotensive patient needs a bolus. Look at their heart rate too. For example, I had a patient the other night, that every time I gave him hydrocodone down his DHT, I would see his SBP rest in the 80's on the A-line. I would just wait it out, and it would come back up within an hour. When it comes to BP, you should really concern yourself more with the MAP than the SBP. When I titrate vasoactive drips, it's off a MAP not a SBP. Look at MAP and HR.

sweetER · Mar 20, 2011

I guess I should clarify. I agree with what everybody else said about assessing your patient and taking into consideration their PMH when administering a bolus. In my ER, though, we run boluses at 999mL/HR 99% of the time - but just because it's going at 999 doesn't mean we're gonna give the whole liter. On older/renal/chf patients we'll still run it at 999 but only give a 250 or 500 mL bolus.