Pt was tilted with feet up

micro, RN · Jun 30, 2002

micro has the answers, but micro is off the clock.....

Mario, you know more than what you yourself credit for.........

hey, my fellow scholarly nurses..........

you are all better worded than I, and more knowledgeable.......

micro knows what micro knows, but just does it.......isn't and doesn't have the words..................

micro and out .....insomnia 101........think there is a post in this last phrase'

micro the nurse wants to retire and just go to that cabin on the hill'

hoolahan, ASN, RN · Jun 30, 2002

Mario, this is called Trendelenberg position. It is used to treat shock. The idea is, to allow gravity to assist what little blood pressure there is to get to the vital organs, heart and brain. I have also seen nurses and docs simply lift the pt's legs with an increase in pressure. Usually they will be simultaneously starting an IV and giving fluids, especially if the shock is from hypovolemia (low circulating blood volume), such as in massive bleeding.

Hope that helps you understand. I am sure others will have other good info to add.

NICU_Nurse, BSN, RN · Jun 30, 2002

Mario,

I am by no means an expert; perhaps a cardiac nurse or someone with more experience could answer this more thoroughly for you. I do know that the position you are speaking of is called the 'Trendelenberg' Position. As you said, the patient's blood pressure had dropped significantly (which could indicate physiological shock and/or traumatic blood loss, possibly third-spaced blood loss), and the nurse flipped the patient so that their feet were up in the air. Basically what this does is allow gravity to push more blood more quickly to the heart while that patient is on their way to ICU. There are more aggressive treatments for serious hypotension, but this is one that is quick and easy to do before you have access to medication, volume expanders, etc. You asked what point at which you would take this action- I would assume immediately if the blood pressure was that low. If you are taking a BP and it is low, always consider that you may have the cuff positioned wrong or human error. You may want to confirm it with a manual BP if you are using a machine. Also look at the patient- if the BP has dropped severely, they will be experiencing symptoms of hypotension, including but not limited to dizziness or weakness. Once you have confirmed it, or are relatively sure that the reading is correct, you would go ahead and do this. It is a simple measure that cannot really hurt the patient while you evaluate what else to do. Sometimes, this position is contraindicated, as in a neuro trauma. If your patient has a head injury, you wouldn't want to have all the blood rushing back towards the heart because it would increase the intracranial pressure, etc. Other vitals or clues you might see are a weak, thready pulse (initially, with blood or volume loss, the pulse may be stronger as the heart works harder to pump blood, but as volume is lost, the pulse will weaken dramatically) or the patient may be sweating or pale. I don't know if a CNA can initiate this position or not; I don't work with adults. ;>) There are times when you would raise the head, but again, I'll leave that explanation to someone else who knows why. ;>P

OBNURSEHEATHER · Jun 30, 2002

Excellent advice from some wonderful nurses! Ask away Mario!

Heather

lgcv · Jun 30, 2002

I usually went to T-berg when a patients pressure was in the 70's or if the pressure was dropping fast. It "pushes" the blood volume up, increasing the pressure and hopefully allowing better perfusion of organs.

It is usually followed by some other treatment...volume, vasopressors or inotropes. It is a stop gap measure that hopefully gives you enough time to treat with other modalities before ischemic arrhythmias etc.., occur.

This is not to say that all patients with a BP of 70 need this, some people live there. It is used for the patients who have a precipitous drop with signs and symptoms.

ageless · Jun 30, 2002

The only thing I can think to add is.....If the patient was on his left side and in trendelenburg, it might have been used as an intervention for a suspected air embolism from a central line, gershong, quinton catheter, etc.... air can enter the vena cava, and move through the RV into the lungs.... making a pulmonary embolism. The premise is to hold the air in the right ventricle until cardiology can do other interventions.

So, was the patient also on his/her left side?

MPHkatie · Jun 30, 2002

good answers about trendelenburg. Officially, I have learned that we are now supposed to only elevate the feet and not lower the head, but generally where I work, our stretchers don't do that fancy manuver....

as far as sitting someone up. I do it all the time to assist with breathing, since it takes any weight off the lungs (Have you ever watched a heavy person flat on their back struggle to get air), and it can also assist when you have some fluid buildup on the lungs- though sitting a person up isn't a cure all for that . As far as a cut and dried signal for these actions, I am not aware of it. Have no fear though, when you are doing ti, you are pretty sure it's what needs to be done...

micro, RN · Jun 30, 2002

beds that automatically do trend or rev trend and other positions are great.....

hey, all.....

anybody else out there not trust the machine bp's.....i like the old fashioned way.........have just seen some wacky bp's and the patient is not reflective of what the bp registers.....

then you take it the old fashioned way.....and like, duh.....

maybe just need a new machine.........

jules/futureRN · Jun 30, 2002

I am not a nurse yet but I had a situation happen like this to me. When I was in labor with my second child, my nurse did this to me. It was after the epideral was put in and she had asked me to let her know if I had a metal taste in my mouth or if my ears started to ring. Well as soon as she said that, I tasted metal and I before I could let her know, I had the ringing in my ears...I dont really remember much more after that except that she tilted my bed. My husband I freaked out after the situation was over. Is this what happened to me? Nobody ever told us anything. :confused:

WashYaHands · Jun 30, 2002

I agree with Hoolahan about the hypovolemic shock. "Face is red, raise the head.....face is pale, raise the tail". Low blood pressure is an indicator and I agree with Micro about taking BP the old fashion way as machines tend to malfunction. It's possible that this pt. had a possible GI bleed? In addition to the low BP, other indications such as blood in the stool or emesis might have tipped the nurse to the cause. She may have guiaced the stool and emesis to determine this, or just the appearance of the emesis/stool. Another factor to consider is drug interactions, particularly HTN meds, antidepressants, and antacids.

Linda

OBNURSEHEATHER · Jun 30, 2002

Originally posted by micro
anybody else out there not trust the machine bp's.....i like the old fashioned way.........have just seen some wacky bp's and the patient is not reflective of what the bp registers.....

Yup micro, we have about 3 or 4 of these machines on our floor, and they all act the way you described.

Someone told us once that in the manual it says that to get a true b/p reading, you should take it 3 times. If you're moving from pt. to pt. the third b/p is the truest b/p measurement, because it takes that long for the machine to calibrate to the patient. Unless it's always staying on 1 patient, hooked up to take it every "x" amount of minutes.

And I can do it the old fashioned way in alot less time than it takes to do 3 on the machine!

Heather