Monday, 16 March 2009

Catch 22

A patients blood pressure dropping can indicate nearly anything, couple this with raising tachycardia(Increased Pulse Rate) and pyrexia(Raised Temperature) and you probably have a patient suffering sepsis. Until the antibiotics sort out the sepsis(assuming a surgical pathway hasnt been taken) you have to deal with the patients blood pressure. it needs to be raised to a point where the whole body is receiving enough blood regularly. The popular method of doing this is hanging saline regularly as well as another IV fluid called gellofusin. The idea is that at least you are keeping the circulating volume up even if the actual contents is a little diluted when it comes to oxygen bearing red blood cells.

A common result of cardiac incidents, or general poor cardiac function is the collection of fluid in the preferies(Oedema), and usually this fluid makes its way onto the lungs. This is pretty easily resolved with a nice little diuretic we use called Furosemide. This causes any excess fluid in the body to be passed through the kidneys, into the bladder and given the condition of most of my patients straight into their cathater bag.

So what the hell do you do when you have a patient who has a plumeting blood pressure and is overloaded to the point where their lungs are severely comprimised?

The doctors caring for this patient decided to try and maintain a balancing act, putting enough fluid in to keep her blood pressure compatible with life whilst putting enough furosemide in to stop her drowning. Not an easy thing to do and I dont envy them.

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