Why bolus with a high BP?

[beachmom]

My husband woke up one night feeling a fluttering heart. His HR was 180. Our daughter took him to ER. I was at work, and when I arrived in ER, they were ready to give him adenosine. His BP was 160's/130's. HR 170's. I noticed they had a liter bolus of LR running.

Why would they bolus someone who's BP was so high? It would make it higher! It seems really contra-indicated to me.

After the med, his HR and BP slowly decreased. After an hour they sent him home. No cause. Just told him to follow up with his doc. BTW, his normal BP is 140's/80's, and he is on HCTZ which keeps him in the normal range.

[Esme12, ASN, BSN, RN]

The ED will hang liter bags of fluid. The are cheaper and it is easier to keep stocked. Second, we usually will try a bolus of fluid to see if hydration will help. . Remember people are comming off the street and are not always forhtwright with their history. Third when adenosine is given it must be followed by rapid IV flush usually with a syringe. Hypotension can ensue. Fourth I have seen patients become asystolic after adenosine.....rare but it occurs.

[ZippyGBR, BSN, RN]

I agree with Esme

high BP does not mean overload, equally low BP does not mean dry as the size of the vessel is variable as well as the pump and the volume of lquid ....

[nurse2033, MSN, RN]

First off Esme12 has it right, so me too. His heart is obviously healthy in that it is sustaining that rate. Your BP has three factors, the container, the pump, and the contents. Pump is going full force, container is probably squeezed to the max by epi dump from the high heart rate. Contents could be low with the other two factors compensating well. Once the heart rate comes down, his whole system could relax into hypotension. The bolus was to prevent that from happening. The MD was probably going off the assumption that his rate could be controlled, so the fluid wouldn't hurt him. Glad everything turned out OK. :)

[mgh000]

everything mentioned above is exactly what we do in the ICU, so dito

[traumaRUs, MSN, APRN]

Per our terms of service, we request that you not ask for medical advice. Please take this up with your husband's medical provider. We hope he is feeling well again.