Hypovolemic

[tchristifulli]

Can you be hypovolemic and not be hypotensive? The body is always adapting vessels to match the volume, so couldn't you be normal tensive and still be dehydrated? I had a pt today with dizziness and weakness Bp 146/78 hr 130. 300 cc bolus decreased his hr to 100.

 

[EMT B]

Yes it is possible. One of the ways the body compensates for low blood pressure (for whatever reason) is by increasing the heart rate. Remember, the factors that control blood pressure are cardiac output, fluid volume, and vessel size. If you think about your phases of shock, the last thing you will see drop is the blood pressure, because the heart is increasing the cardiac output to compensate for low pressure. That is why the shock stage is called Compensatory Shock.

 

[tchristifulli]

Exactly, thanks

 

[triemal04]

So...you've never (as far as I know anyway) identified exactly what your level of education is. From your avatar, you would seem to be identifying yourself as a critical care paramedic.

Is that really the case? Because no offence, but the questions you are asking indicate a sub-par knowledge level for someone at that point to say the least. Is that just what your end goal is?

It might help to know that when answering your questions.

 

[Akulahawk]

You would also see some peripheral vasoconstriction. So, yes, it's absolutely possible. It's also why your 300 mL bolus had the effect of lowering the heart rate. I had a somewhat similar patient a few years ago. I had a "normotensive" patient that was very dehydrated, to the point of unresponsiveness. Fortunately she had been keeping Vital Signs records daily so I could see that she normally had a BP around 175/95. She was managing to take her cardiac/BP meds so her HR didn't increase to compensate.

I ended up giving her about 750 mL of NS, which made her go from GCS 3 to GCS 15. I quite suspect that had she stopped taking her meds, she probably would have only become dizzy and weak... until she could rehydrate herself.

 

[usalsfyre]

Normotensive hypovolemia is pretty much the definition of compensated hypovolemia shock.

 

[VFlutter]

You will also see patients with early sepsis be normotensive, or even hypertensive, even tho they are severely hypovolemic because they are tachycardic and perhiperally vasoconstricted. It is basic physiology.

 

[usalsfyre]

You will also see patients with early sepsis be normotensive, or even hypertensive, even tho they are severely hypovolemic because they are tachycardic and perhiperally vasoconstricted. It is basic physiology.

Which would be a form of hypovolemic shock....

The average sepsis patient isn't vasoconstricted till later. The CO increase compensates for the vasodilation they're experiencing. Look up warm vs cold sepsis.

 

[mycrofft]

Can you be hypovolemic and not be hypotensive? The body is always adapting vessels to match the volume, so couldn't you be normal tensive and still be dehydrated? I had a pt today with dizziness and weakness Bp 146/78 hr 130. 300 cc bolus decreased his hr to 100.

You administered a bolus and then the HR increased. Bolus of what?

A doctor at the receiving ER will hear or read this and turn to someone and say "Is it a coincidence or is the bolus creating the change?". Or something less charitable about the field person presuming that their treatment caused a change when there is only timing to suggest it did (unless the bolus had drugs in it).

Try something like this: "1500hrs: Pt reports dizziness and weakness, Bp 146/78 hr 130. Start IV 300ml XCYZ solution" (site)
1510hrs: IV 300 ml of XYZ solution IV completed ..." and give new vital signs, other S/S.

HR of 130...regular, irregular? (Irregularly-irregular, or regularly- irregular?). EKG reveal sinus tach, or what? (Don't trust pulse-ox, its software can be confused by irregular rhythms into inaccurate rate displays). A paroxysmal arrhythmia and palpated pulses (or pulse ox) could yield the same result if you did nothing but play them music from their IPod.

Yes, you can be normotensive/normal pulse rate and still have the potential to slip back into a hypovolemic state due to a number of situations tipping the circulating fluid volume versus/and circulatory vascular volume readings the wrong way. (Not a balance scale, more of a johari window diagram).

Some causes:meds, continued bleeding, release of tourniquet or entrapment effects, sudden electrolyte imbalance (crush syndrome or IV potassium overdose ala Kavorkian). Decompensation.

 

[tchristifulli]

I think your looking to deep into my post. I did not write this as I would a narrative. It was just a quick example of how my patient who was hypertensive and tachycardic responded to a NORMAL SALINE bolus. My coworker said " why do a bolus he is hypertensive ?" Which I replied that due to his increased temp and recent V/P shunt placement he could have an infection process and still be dehydrated. This bolus did in fact reduce his HR to 90 on our 10 minute transport. He was discharged 3 hours later with a antibiotic and diagnosed with fever/ dehydration. I am in fact a Critical Care Medic and I ask questions to hear others view points on them. I think saying I'm a sub par paramedic is a very ignorant statement to make. In our field things are always changing and I love hearing others view points. That being said if you don't have something topic related and constructive to say then I really don't care.

 

[Christopher]

Normotensive hypovolemia is pretty much the definition of compensated hypovolemia shock.

At the Ironman I worked this weekend this would account for nearly half of our patients.

 

[EMT B]

edit: I pm'd you...off topic