Hey Y'all
I did CoronaryCare 20yrs ago. When they introduced drive-thru cath labs and one-day heart attacks, it quit being so much fun and I migrated to Trauma.
Now I'm working in a small combined Medical-Cardiac unit. Mostly my old cardiac skills are worthwhile. Patients' hearts today are unchanged from those a few decades ago.
But I've had a little lady pt the last few nites that I wanna ask for opinions about. She's only 66. Old chart has a hint of previous mental illness--but she has not shown it during this admit. NursingHomePt due to remote spinal trauma and surgeries--bedfast and wheelchair dependent; moves everything & skin intact but very weak and 'deconditioned'. Comes in with Inferior MI. Refuses Cath and intervention.
So this is my question: She looks to me like a perfect model of R Heart failure. Very low BP (70's Systolic at times) and very very poor urine output (10-20cc/hr) and BUN increasing daily. Heart rate 70s & 80s. Chest clear as a bell; sats 98% with nasal O2 at 2L. Back when I knew anything, the answer was GIVE IV FLUIDS. The rational was that the high CVP would not translate into pulm edema because the weaked R Ventricle would not put so much fluid into the lungs that the undamaged L Ventricle wouldn't take it out, and the more blood that can be sent to the L V, the better.
But the Dr.s are not treating her this way at all!! I call and get no orders for fluids. They round on dayshift and even DC the KVO fluids. I did get one junior partner in the admitting Dr.'s group ("I don't know the pt but what's your question?") to let me give a liter of NSS overnight. The urine briefly picked up and BP was around 100 by the end of the shift. Then the Cardiologist 'rounded' the next AM and wrote "DO NOT SALINE LOAD THIS PT!!"
I'm pretty sure I remember my stuff. What's changed? Anybody?
This isn't a 'rant' by the way. I'm hoping to get a serious answer.
Papaw John
(scratching his thin greying head)