Pt arrived to unit in respiratory distress, was intubated and put on CMV 80% FiO2. B/P low on arrival in 70's-80's and pt got 500ml NS bolus.
B/P remained low in 70's after bolus (boluses were given over 1 hr)
HR 130-138
Temp 40.2 C
RR maybe 16-22
0 urine out for 2 hours upon arrival (until started on pressors)
report states pt has hx of HTN, CHF, and possible UTI and PE
Pt got bolus of 500ml NS, B/P still low with MAP about 50-52.
Started another 500ml bolus but B/P remained low, medicated for temp, and started on Vaso 0.04units/minute to achieve MAP> 65.
>>>>Would you argue that Phenylephrine should have been started first?
The Vaso combined with continuous bolusing of 250ml NS per hour achieved MAPs in 65-70's and Syst B/P 90's. o2 sat stayed 97% the whole time (even with weaning Fio2 to 50%) Neo was added later to assist B/P
Pt on Heparin gtt, then determined to have definite DVT in leg. PE undetermined bc poor kidney functioning. Creat 6.3
When checking labs, lactate came back 1 something, and the ICU fellow states "pt is not septic-they don't even have an elevated lactate"
>>>>>I have not found anywhere that lactate level is a determinant of sepsis or MODS.
Thanks dude. Hey, with a heart rate in the 140's, I feel better not contributing to the heart rate increase. In fact, I have seen patients maxed out on Levo with SVT, and consequently we stopped the Levo because of this and started on other drugs. Not sure where you work, but I've seen all kinds of stuff : )
Really enjoy the input here--and sometimes miss the days of the Swan. Yes, yes, we can go on and on about not having them used. It all boils down to the patient responded and got better. Good job!
poppy07
208 Posts
Thanks dude. Hey, with a heart rate in the 140's, I feel better not contributing to the heart rate increase. In fact, I have seen patients maxed out on Levo with SVT, and consequently we stopped the Levo because of this and started on other drugs. Not sure where you work, but I've seen all kinds of stuff : )