Blood pressure spikes and bp accuracy questions

[mcd24RN]

I figured I would post this question in the critical care section because Critical Care nurses may have more experience with my question. I am a relatively new new RN working at a LTC for vent dependent patients. Today, I had a patient with pneumonia, normally hypertensive with hypotension all shift (90s over 40s) for about 6 hours, all BP meds held, until she desaturated and stopped producing urine at which point she was sent the local ER. The paramedic that transferred her to the ER said that her BP during transport and upon arrival to ER was 146/82 and the ER nurse also found her to be hypertensive. Then later I talked to the ER and she was admitted to the ICU with sepsis. Is it possible for her BP to spike from hypotensive to hypertensive so rapidly? Within about 30 minutes from 98/48 to 146/82? Or did I make some type of mistake? Any help is greatly appreciated, can't stop questioning myself!

[Biffbradford]

I guess holding the BP meds helped! :) Could be that all the excitement of the trip to the ER raised her BP, but as soon as she settles into her new bed - WHAM!, she'll crash. You done good.

[Hawkeye-RN]

hypotension, desaturation, oliguria/anuria = MODS-multi-organ dysfunction syndrome from severe sepsis from pneumonia. You did great, but this pt needed to be admitted sooner for aggressive management. The BP during transport and in ER are just that; What we need are the trends like you noted BP's in 90s/40s for over 6 hrs. Those tells us more. By the way a drop of 20mmHg on a pt who is "normally hypertensive" can significantly affect perfusion.