Advice: On An MD Order

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Ok so I was taking care of this pt, without giving too much info, his systolic pressures at night usually are 90-100 systolic maybe once or twice he'll drop to systolic of 80s (which I watched but dont like), but his MAP stays above 60s. I was off a few days and started taking care of him again and the nurse told me that his systolics has been 70-80 with MAPs consistently in the 50s. When asked what the MD order she stated, that they were aware and didnt want to do anything. The MD was on the unit so I trended the bp for her to see and she said, not to page her unless it "stays below a MAP of 50 for a while." At one point systolic even in the 60s at times, she said its fine. I didnt feel comfortable with this, MAPs of 60 ok I can deal with this but less than 50?????? and what is for a while? Anyone know of research that support of MAPs less than 50???? What are your thoughts on this?

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Well it is definitely a rare occurrence :)

too funny....:)

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
It was originally developed as a pulmonary hypertension med. The subjects in the trial just reported a "happy" side-effect, leading to it's other, more popular use.

and more profitable!!!!!!!!!!:smokin:

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Think about it for a moment. Why is it important to maintain a MAP of 60? End-organ perfusion, right? Well, if the patient is already on dialysis, then he has end stage renal failure. You're not going to muck up his kidneys by letting his MAP be in the 50s. Your concern would then be if the patient is symptomatic, i.e. altered level of consciousness, which would be an indicator of not enough oxygen to the brain (remember that changes in LOC are early signs of poor perfusion). As long as he's asymptomatic, I'd be okay with that doctor's order.

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:lol2: I gave cialis last week to a female pt with essential pulmonary HTN. I had to look it up to satisfy my "what the ???" reaction, but when you think about its mechanism of action, it makes sense.

I had a LOL on Ritalin once, to counteract the fatigue caused by her metoprolol.

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We use viagra on our older chronic preemies......PPHN

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