dudemursestudent

For diprivan (propofol) you also need to be aware of the possibility, although rare, of propofol infusion syndrome. This is characterized by cardiac arrhythmias, metabolic acidosis, circulatory collapse. Early cardiac signs can include brugada like changes to the ECG. It is often fatal, and is currently debated in the literature. High doses, and long term sedation seem to be associated with this, however some episodes have occurred during the first day of sedation. Dr. Jeff Guy's podcast ICU rounds has a good discussion of this phenomenon. Although it is rare if you are ever administering propofol you NEED to be aware of this complication.

check a pulse, or look at the wave form on the pulse ox or arterial line. Pulse is always front line assessment though

Sorry i didn't make my self clear, i'm talking about working in the prehospital environment, when transporting a pt to a hospital with suspected internal bleeding and administering iV fluids you do not want to raise the blood pressure too high so that the pt bleeds out before getting to the OR. its just when everything is moving in the truck and your trying to get a pressure sometimes it's hard to palp the radial, and not always sure its there. like is pulsus paradoxus where the intrathoracic pressure of breathing can stop a radial from being palped. This is not a place that i want a pt to be in but if your trying to get a pressure is there anouther way or does the pt just not have one you can get. I checked out the Trauma.org link and that is the stuff i was talking about. just looking for some tips in how to carry out the trauma protocols and keep the pt beating. also Focker0014 i think i understand that if there isn't a pressure to get than you just can't get it. (without an arterial line)

So I'm in nursing school and i've been an EMT for a while, we always talk that in general the systolic BP is at least 90 if you can palp a radial pulse. But in trauma and internal hemorrhage you want to keep the systolic low to slow bleeding, sometimes 70-80ish at that point you might not feel a radial pulse, how to you get a manual bp when it is too noisy to auscultate (like it always is in the field or ER)? or do you just slap on the NIBP and just hope for the best?