# Question about a call



## EMSpassion94 (Jun 26, 2011)

I just recently transported someone I knew to the hospital for "low blood pressure." Dispatched for Illness. Arrived on scene to find PT in passenger side car seat sitting, not looking too well. Sort of pale, responsive to some verbal stimuli. While obtaining PT info from wife, was told that he had a "hernia surgery" within the past year. BP used to stay high before the surgery, but after surgery would stay on the low side? Doc still had him on high BP meds though. Had a few "mini-strokes" before. When PT BP was taken, it read "67/33." Transported PT in trendelenburg, applied O2 15lpm via NRB, and medics established IV. PT BP came up a little by the time we were at the hospital, but still low. Talked to PT wife yesterday(call was last week) and she said after they admitted him to the hospital they ran tests and found he was dehydrated and had a "mini-stroke" so she said. My question is, I thought if you had a stroke, your BP becomes elevated? Is there a definite correlation between BP and stroke PT's, or could the dehydration have been causing low BP?


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## MMiz (Jun 26, 2011)

I'm not an expert, but I know that sudden hypotension may be an indicator of a TIA.  Dehydration can also cause one's BP to drop.

I wouldn't consider blood pressure to be a major indicator of a stroke.  Did your assessment reveal anything else?


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## MrBrown (Jun 26, 2011)

There are two types of stroke - haemorrhagic and ischaemic.  You are going to see high blood pressure in a haemorrhagic stroke far more than an ischaemic stroke, although it is still possible and we are not talking in absolutes here.

Blood pressure is complex; controlled and influenced by many different hormonal and physiologic mechanisms and is not highly specific to any definitive pathology really.  You can say oh this guy passed out because he was really hypotensive which is fine, but ten thousand different things could cause him to become hypotensive or that bloke who is hypertensive had a stroke, it many have been his hypertension, smoking, diabetes and hyperlipidaemia which caused him to have a stroke or it might have been the thombi that formed on the stent they put into his ticker which broke off and caused his noggin to go kaput.

Dehydration will also cause low blood pressure due to intravascular fluid deficit


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## EMSpassion94 (Jun 26, 2011)

MMiz said:


> I'm not an expert, but I know that sudden hypotension may be an indicator of a TIA.  Dehydration can also cause one's BP to drop.
> 
> I wouldn't consider blood pressure to be a major indicator of a stroke.  Did your assessment reveal anything else?



Nope, nothing out of the ordinary. All other vitals turned out fine, as far as I can remember. Just wasn't responding too well when we got there, kinda of in and out of it..drooping in his chair..fluttering his eyes sometimes, etc. After placing PT on NRB, trendelenburg and IV line, stated he was feeling a little better, not so dizzy as he was. Nothing else revealed by assesment.


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## Cawolf86 (Jun 26, 2011)

Often times CVA patients are found to have an increased systolic blood pressure due to the body attempting to compensate for decreased perfusion to areas of the brain (Cushing's response).

An ischemic stroke can also be caused by hypotension that interferes with adequate blood supply to the brain (dehydradtion may cause systemic hypotension). Unlike an ischemic stroke caused by an embolus or thrombosis - with return of adequate pulse pressure the area is reperfused which will result in less long-term damage than with an embolus/thrombus. In these cases a hemorrhagic stroke has to be ruled out prior to treatment - resulting is increased hypoxic damage to brain tissue.

I may be off but this is my general understanding.

TLDR: Ischemic strokes do not present with a certain blood pressure as they can be caused by various factors.

Edit: brown beat me


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## EMSpassion94 (Jun 26, 2011)

MrBrown said:


> There are two types of stroke - haemorrhagic and ischaemic.  You are going to see high blood pressure in a haemorrhagic stroke far more than an ischaemic stroke, although it is still possible and we are not talking in absolutes here.
> 
> Blood pressure is complex; controlled and influenced by many different hormonal and physiologic mechanisms and is not highly specific to any definitive pathology really.  You can say oh this guy passed out because he was really hypotensive which is fine, but ten thousand different things could cause him to become hypotensive or that bloke who is hypertensive had a stroke, it many have been his hypertension, smoking, diabetes and hyperlipidaemia which caused him to have a stroke or it might have been the thombi that formed on the stent they put into his ticker which broke off and caused his noggin to go kaput.
> 
> Dehydration will also cause low blood pressure due to intravascular fluid deficit



what exactly is the difference between hemmorragic and ischemic strokes?


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## EMSpassion94 (Jun 26, 2011)

Cawolf86 said:


> Often times CVA patients are found to have an increased systolic blood pressure due to the body attempting to compensate for decreased perfusion to areas of the brain (Cushing's response).
> 
> An ischemic stroke can also be caused by hypotension that interferes with adequate blood supply to the brain (dehydradtion may cause systemic hypotension). Unlike an ischemic stroke caused by an embolus or thrombosis - with return of adequate pulse pressure the area is reperfused which will result in less long-term damage than with an embolus/thrombus. In these cases a hemorrhagic stroke has to be ruled out prior to treatment - resulting is increased hypoxic damage to brain tissue.
> 
> ...



SO....his dehydration, which could have cause his hypotension, could POSSIBLY have cause the ischemic stroke?


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## Cawolf86 (Jun 26, 2011)

EMSpassion94 said:


> what exactly is the difference between hemorrhagic and ischemic strokes?



A stroke or CVA is when there is a neurological deficit or compromise due to an insult of the vasculature.

Ischemic (ischemia) is an interruption of the blood supply due to a blockage or interruption  of the vessel such as from a thrombus or emblous.

Hemorrhagic strokes occur when intracranial bleeds cause an increase in pressure that limits blood supply to brain tissue.


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## Cawolf86 (Jun 26, 2011)

EMSpassion94 said:


> SO....his dehydration, which could have cause his hypotension, could POSSIBLY have cause the ischemic stroke?



Yes - though if the deficits did not persist beyond 24 hours it is not a stroke - it is a TIA. TIA and CVA are the same thing but a TIA resolves within 24 hours.


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## MrBrown (Jun 26, 2011)

EMSpassion94 said:


> SO....his dehydration, which could have cause his hypotension, could POSSIBLY have cause the ischemic stroke?



Dehydration may cause hypotension, but hypotension does not cause ischaemic strokes.

An ischaemic stroke can either be acute or the result of a long history with multiple risk factors.  Acute ischaemic strokes are usually the result of fat emboli from fractured long bones and some medical interventions.

The vast majority of people who have ischaemic stroke have a history of hypertension, hyperlipidaemia, AF, smoking, diabetes etc.


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## Cawolf86 (Jun 26, 2011)

MrBrown said:


> Dehydration may cause hypotension, but hypotension does not cause ischaemic strokes.



Still and always learning - so I have a question on this then. I have heard of TIAs and CVAs called "watershed strokes". I looked this up in my medical dictionary and it refers to these as ischemic events. The hypoperfusion combined with certain medical issues (CHF, ASHD) leads to a CVA in areas of the brain with less pressure. As ischemia is decreased perfusion - which this event would fall under.

-Looking to learn!


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## Lifeguards For Life (Jun 26, 2011)

Cawolf86 said:


> Still and always learning - so I have a question on this then. I have heard of TIAs and CVAs called "watershed strokes". I looked this up in my medical dictionary and it refers to these as ischemic events. The hypoperfusion combined with certain medical issues (CHF, ASHD) leads to a CVA in areas of the brain with less pressure. As ischemia is decreased perfusion - which this event would fall under.
> 
> -Looking to learn!



Google "global ischemic stroke".

*post from phone, otherwise would write more. Incidentally rhinos the same reason inhale not responded to pm from chimp yet


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