Hr bp drop??

[*Butterfly8*]

If given an order to start 500ml ns bolus and bp is 78/50 hr 41. You were told pt would die within the next few days but not exactly expecting today. fast respiratory rate for the day before and that day. Would the bolus have kept them alive for long or at all if given immediately? There were Tons of other stat orders and other lab people workin on them as we'll as starting another iv before bolus was given. Pt passed before bolus given

[eatmysoxRN, ASN, RN]

What orders were being implemented rather than the bolus?

[Mully]

The bolus should have been priority number one honestly. People die because their vital organs aren't being perfused. That's why the American Heart recommends thinking about circulation first. Were they symptomatic? Sounds like there wasn't much you could do long term for this pt anyways though? Were they a DNR?

[ChristineN, BSN, RN]

If the pt was a DNR/DNI and was actively dying, I would have questioned the futility of giving fluids. Often times if someone is actively dying, lab draws/tests should be dc'ed and priorities should be on comfort, not trying to prolong the inevitable

[Guest343211]

Yes, what was this person's code status? I'm guessing it was questionable, hence the "bridge" attempt.

[BCRNA]

I doubt that you would have had an IV big enough and would have given the bolus fast enough to make a difference. Fluid is the preferred treatment for hypovolemia, but a pressor is often given to bridge the time that it takes to give the fluid. Was the patient in heart failure or having a vagal reaction? To make a difference in a couple of minutes, you would have to have at least an 18 gauge IV and put the fluid on a pressure bag.

[teresav234]

We do not have enough information to help you with this question.

There are many things that can cause a pt to have these vitals. Impending death is one.

We would have to know what other orders were given; however, hang a bag of fluids and figure out the rest of the orders as the bolts is going in. It probably did not matter in this case, too late, but it might in the future.