Asymptomatic hypotension?

johnrsemt

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I weigh 275, and walk around 80/40 and I am asymptomatic, usually. Except I am usually cold.
I have been as low as 62/24, when I walked in to donate blood (for some reason they wouldn't let me donate), but again no symptoms.
But I am weird
 

BobBarker

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As many have said, definitely questioning a code 3 response. Practically everything in LA here is code 3 transport. We held the wall the other day and LAFD comes blaring in the ER bay at 2AM with a homeless man C/C can't poop, nothing else acutely wrong, no treatments given. My buddy who works on a private ambulance with LA County Fire says anytime a medic jumps in it's automatically code 3, which completely goes against regulations but oh well.
 

E tank

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I weigh 275, and walk around 80/40 and I am asymptomatic, usually. Except I am usually cold.
I have been as low as 62/24, when I walked in to donate blood (for some reason they wouldn't let me donate), but again no symptoms.
But I am weird.
Very broadly speaking, odd numbers like that, if accurate, merit further investigation. Doing stuff like checking both arms (subclavian artery stenosis will give erroneously low numbers) is a way to verify what you're seeing. Short that anything from endocrine to heart valve dz can be in play. Stuff like this may be tolerable the the 20-30 age range, but not in the 50-60's.
 

E tank

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As many have said, definitely questioning a code 3 response. Practically everything in LA here is code 3 transport. We held the wall the other day and LAFD comes blaring in the ER bay at 2AM with a homeless man C/C can't poop, nothing else acutely wrong, no treatments given. My buddy who works on a private ambulance with LA County Fire says anytime a medic jumps in it's automatically code 3, which completely goes against regulations but oh well.
Sounds like the situation in Rhode Island...fire is in charge and and the EMS directors are eunuchs.
 

EpiEMS

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The last question in the comment that I quoted is where my information is relevant. Pretty much anything and everything in LA/OC gets a code 3 transport.

Wouldn’t that get flagged by QA? Seems dangerous without clinical benefit — assuming calls are verbally not beyond the scope of the provider on board to manage.
 

DesertMedic66

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Wouldn’t that get flagged by QA? Seems dangerous without clinical benefit — assuming calls are verbally not beyond the scope of the provider on board to manage.
In a well established system yes it would. Let’s just say there are several systems in CA that are below standards.

For instance on my ground ambulance job, I can run lights and sirens all day long for every transport and nothing would ever be said as lights and siren transports aren’t a main thing that is tracked.
 

E tank

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In a well established system yes it would. Let’s just say there are several systems in CA that are below standards.

For instance on my ground ambulance job, I can run lights and sirens all day long for every transport and nothing would ever be said as lights and siren transports aren’t a main thing that is tracked.
No county policy? If you were to t-bone someone or take out a pedestrian in the course of a routine BLS transfer, what would the lawyer/liability fallout be? Seems the first thing an injury lawyer would do is subpoena the DR and ambulance records.
 

DesertMedic66

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No county policy? If you were to t-bone someone or take out a pedestrian in the course of a routine BLS transfer, what would the lawyer/liability fallout be? Seems the first thing an injury lawyer would do is subpoena the DR and ambulance records.
County policy only dictates what hospital we transport to. It doesn’t specify transport type or transport mode.
 

E tank

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County policy only dictates what hospital we transport to. It doesn’t specify transport type or transport mode.
That would make sense, as the county would not be wanting to dictate discretionary medical decisions but then there is the liability of the service itself which could be substantial, I'd think.
 

EpiEMS

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For instance on my ground ambulance job, I can run lights and sirens all day long for every transport and nothing would ever be said as lights and siren transports aren’t a main thing that is tracked.
Interesting -- and of course, if you don't chart it, harder to prove that you were running hot, I suppose.
That would make sense, as the county would not be wanting to dictate discretionary medical decisions but then there is the liability of the service itself which could be substantial, I'd think.
Agreed from a liability perspective, would think that since consensus is that running hot, particularly from calls that can be managed well by EMS personnel, diverges from standard of care.
 

DesertMedic66

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Interesting -- and of course, if you don't chart it, harder to prove that you were running hot, I suppose.

Agreed from a liability perspective, would think that since consensus is that running hot, particularly from calls that can be managed well by EMS personnel, diverges from standard of care.
It’s one of the mandatory things we have to chart, there is a button selection for it and the chart won’t lock if that is blank. So technically it is something that can easily be checked by QA/QI with a couple of mouse clicks however the QA/QI process we have for my ground agency is not the strongest and really only focuses on things paramedics have done that will kill patients.
 

RedBlanketRunner

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The OP would make an excellent training scenario. Thinking on your feet, coping when nothing is quite right. Very nice to hear the pros chime in here with their alternative dx methods.
 

johnrsemt

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E-Tank, Back when I worked in a small Hospital ED, we where talking one night when it was relatively slow about 'freaky' patients that are normally hypotensive, and I mentioned that my BP is normally low. The doctor on didn't believe, so we all (doctor, 2 nurses, and 2nd medic {left 1 nurse at nurses station) wandered into trauma room).
I was dressed as normal: tech pants, and long sleeve shirt under scrub top, because I was cold in the AC. Numbers may be off but I was basically 84/48 upper extremities: upper and lower arms, automatic and manual cuffs. I think I was 86/50 on the legs: thighs and calf's. ED doc who was 29, and worked out every day was on HTN meds because of his BP.

My BP 5 minutes ago was 82/50 left arm, 84/48 right arm automatic cuff, so normal. At my annual physical in January it was approx the same which freaked out the Patient Care Tech. My family doctor offers every year to put me on medication to increase my BP, but he just says that because he is Hypertensive.
Your comment about "Stuff like this may be tolerable in the 20-30 age range, but not in the 50-60's"? I have been this way my entire life and oh yea I am now 56: so maybe some people can handle it their entire life (although I would give up another 20 points of BP to be warmer normally. It is 72 degrees in the building at work and 80 deg out side and I am in a hoodie and freezing.
 

E tank

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E-Tank, Back when I worked in a small Hospital ED, we where talking one night when it was relatively slow about 'freaky' patients that are normally hypotensive, and I mentioned that my BP is normally low. The doctor on didn't believe, so we all (doctor, 2 nurses, and 2nd medic {left 1 nurse at nurses station) wandered into trauma room).
I was dressed as normal: tech pants, and long sleeve shirt under scrub top, because I was cold in the AC. Numbers may be off but I was basically 84/48 upper extremities: upper and lower arms, automatic and manual cuffs. I think I was 86/50 on the legs: thighs and calf's. ED doc who was 29, and worked out every day was on HTN meds because of his BP.

My BP 5 minutes ago was 82/50 left arm, 84/48 right arm automatic cuff, so normal. At my annual physical in January it was approx the same which freaked out the Patient Care Tech. My family doctor offers every year to put me on medication to increase my BP, but he just says that because he is Hypertensive.
Your comment about "Stuff like this may be tolerable in the 20-30 age range, but not in the 50-60's"? I have been this way my entire life and oh yea I am now 56: so maybe some people can handle it their entire life (although I would give up another 20 points of BP to be warmer normally. It is 72 degrees in the building at work and 80 deg out side and I am in a hoodie and freezing.
So a MAP of about 60 mm Hg....that by strict definition is not hypotensive for a healthy individual. Hypotension is relative too. It just means organs are not being perfused. 130/80 could be hypotensive to someone.
 

mrhunt

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1: Epi was WAAY too agressive a treatment Imho.
2: She stood up and Remained asymptomatic which just screams inaccurate BP. Likely would have DFO'd from + orthostatics or something.
3: Sure, I'd start a line and give a 250 bolus to be on the safe side, but def not lights and sirens. ESPECIALLY considering the pt literally has no complaints and Is presenting fine.
 

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