Need you advice on an MD order

Specialties MICU

Published

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, but his MAP stays above 60s. I was off a few days and started taking care of him and they nurse told me that his systolic 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." systolic even in the 60s at times, she said its fine. I didnt feel comfortable with this, MAPs of 60 ok but less than 50?????? and what for a while? Anyone know of research that support of MAPs less than 50???? What is your thought.

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Specializes in NICU.

My thought is that he will probably go into kidney/liver failure.

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Specializes in Critical Care- Medical ICU.

I think you would be killing kidneys. I've never been asked to titrate pressors for a goal of anything less than a MAP of 60. I mean, even a MAP of 60, (although in the ICU many times we are happy to see a MAP of 60+) is still not so great for organ perfusion. I don't understand how the MD would be ok with that, its not that hard to start a patient on a low dose of pressors like even 5mcg/ min of Levophed or so, so why would they just sit there and watch when the tools to fix the problem are right there...

Plus, wouldn't it be nice for them to at least be concerned as to why the BP is trending downwards in the 1st place??

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Specializes in Critical Care- Medical ICU.

And also, what is "a while"?? Long enough to cause permanent organ damage? Yikes!

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Some patients just run low. Couldn't hurt to throw something like Midodrine at them.

If someone is consistently 80's/30's across numerous admissions, and has no ill effects, can wake up easily, then the medical team is right in not really caring what their BP is. Neuro patients, quads, a lot of times have really low BP and it doesn't effect them much, if at all.

If you have someone who came in 130's/60's and is now consistently 80's/30's, then you have reason to be alarmed and need to work your way up the chain of command.

It sounds cliche, but look at your patient, not the numbers. Sounds like a shift in SBP from 80's to 70's isn't a huge deal for someone who consistently runs low.

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Specializes in ICU.

Just moved so not been working since March, but I thought midodrine was going off the market? Did it stay? I agree some people just run low bp, was the UO decent? And if that is what the doc is fine with make her commit to a time, 'shall I call if the patient remains low in 1hour? 2 hours?' then write the order, of course after you clarify to the md. "SO, if her MAP is less than 50 for 2 hours you want me to notify you?". Some docs don't like it but CYA is the game. Good luck

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