We were called for nursing home to a severe hypotensive patient. Upon arrival, we found a 85 yo female severe pale, conscient but disorientated in space and time.
The nurse state that the patient had a vomit episode 2 hours before, and had a severe diarrhea since yestarday. In the last 30 minutes, the patient becames more disorientated, confuse, pale, with a blood pressure of 70/50 mmhg, so the nurse put the patient in trendlenbourg position and starts a bag of normal saline wide open,with little BP improvment.
GCS 14 (4-4-6). Pupils equal and reactive to light.
Vital signs: 81/54 mmHg, HR: 60 bpm with barely palpable radial pulse. Carotid pulse weak and regular. IV normal saline running wide open. Capilary refill time 2 seconds.
RR: 21 cpm with some dyspnea. Pulse ox: 92% on room air.
Tympanic temperature: 35,5 ºC
BGL: 98 mg/dL
chest auscultations reveals some crackles in both lungs bases.
Abdomen is soft, with no pain to palpation in all quadrants.
Severe right leg edema with cellulittis. Godet +++/++++
12-lead ecg: sinus rythm.
Regular meds: Omeprazole20mg, beta-histine 24 mg 2id, alprazolam 0,25 mg 3id, vitamin b12 1g, tramadol 37,5 mg + 375 mg 3id, and recently, amoxicilin/clavulanic acid for leg cellulittis.
So, we put some O2 via simple facial mask at 5 liters, and switch the normal saline for ringers lactate.
Durint transport to hospital, pulse ox goes for 98% and BP 87/54 with ringer's lactate running wide open.
Any thoughts?
The nurse state that the patient had a vomit episode 2 hours before, and had a severe diarrhea since yestarday. In the last 30 minutes, the patient becames more disorientated, confuse, pale, with a blood pressure of 70/50 mmhg, so the nurse put the patient in trendlenbourg position and starts a bag of normal saline wide open,with little BP improvment.
GCS 14 (4-4-6). Pupils equal and reactive to light.
Vital signs: 81/54 mmHg, HR: 60 bpm with barely palpable radial pulse. Carotid pulse weak and regular. IV normal saline running wide open. Capilary refill time 2 seconds.
RR: 21 cpm with some dyspnea. Pulse ox: 92% on room air.
Tympanic temperature: 35,5 ºC
BGL: 98 mg/dL
chest auscultations reveals some crackles in both lungs bases.
Abdomen is soft, with no pain to palpation in all quadrants.
Severe right leg edema with cellulittis. Godet +++/++++
12-lead ecg: sinus rythm.
Regular meds: Omeprazole20mg, beta-histine 24 mg 2id, alprazolam 0,25 mg 3id, vitamin b12 1g, tramadol 37,5 mg + 375 mg 3id, and recently, amoxicilin/clavulanic acid for leg cellulittis.
So, we put some O2 via simple facial mask at 5 liters, and switch the normal saline for ringers lactate.
Durint transport to hospital, pulse ox goes for 98% and BP 87/54 with ringer's lactate running wide open.
Any thoughts?