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Discussion

Elevated BP's and PE

Without giving too many details, a while ago I had a patient who's BP's were difficult to control during one of my shifts. To avoid HIPPA, I don't want to give the patient's diagnosis. But throughout the shift the patient's blood pressures were systolic 180-190; I was in touch with the provider and we treated once with IV Lasix. BP dropped to 150's systolic. At a routine VS check hours later, BP was once again elevated in 180's-190's; we tried IV hydralazine, one hour later no change, so I gave some other meds (I think another dose of IV Lasix plus PO clonidine).

BP's were still elevated next shift, but then dropped back down to normal half-way through the shift without any further treatment.

Next day patient is diagnosed with a PE after increasing SOB. During my care, patient's other vital signs were WNL. Patient's sats were good on RA (on pulse ox). Patient did not complain of any worsening pain. Though patient was a bit edematous (generalized and extremities) and complaining of swelling, thus the IV Lasix doses.

My question is - were the elevated BP's related to the PE? Did I miss something?

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    Doesn't seem like it.

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    HTN is a risk factor for PE, did they have a long standing history of HTN or was this new onset?

    Also, giving a diagnosis on here will not break HIPAA

    Edit: knowing the history and diagnosis may help with finding an answer

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    Pulmonary Embolisms aren't usually associated with hypertension. If anything, a severe case of Pulmonary Embolism will present with hypotension due to right ventricular strain (the right ventricle is struggling to pump blood into an occluded pulmonary artery). Since you didn't include pertinent data on the patient in your post (which is totally your prerogative), it is hard to make an educated guess on what caused your patient to have a PE. Maybe a clue can be gathered from the fact that the patient has leg swelling? Sometimes, these are caused by DVT's which can dislodge and embolize to the pulmonary artery (clots follow the course of venous circulation: leg vein --> inferior vena cava --> right atrium --> tricuspid valve --> right venrticle --> pulmonic valve --> pulmonary artery). A Doppler Ultrasound of the lower extremities is usually done to rule this etiology out. When I'm faced with clinical questions like this, I find it helpful to talk to the providers involved in the patient's care to enlighten me. I'm sure they will be happy to discuss the case with you.

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    I guess I know exactly why the patient got a PE, this was a pancreatitis patient. I have see all sorts of complications with pancreatitis, from ARDS, PE, afib, etc. It can be a nasty diagnosis. Hx of HTN in the patient. I was just wondering if I missed a "sign."

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