Sublime
LP, RN
- 264
- 6
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So I had a transfer coming out of small rural ER going to a large downtown facility yesterday. I get there and am told that a 80 y/o female came in for SOB. Pt. is reportedly hypotensive and tachycardic with low oxygen sats.
Pt. has A-Fib with RVR at a rate of 100-110. Blood pressure is around 70/40 and has been hanging around that number consistently. Pt. has CHF and dementia. This patient also has a signed DNR.
Doctor says to me "Hey do you guys have CPAP? We wanted to put her on it but all ours are being used so we couldn't." I tell him we do and he says we need to use it on her.
Upon entering room and assessing patient it is obvious she is in late stage dementia, she will not answer questions appropriately and yells / groans any time she is touched. Daughter in room states this is her normal mentation. Otherwise she is awake, alert and breathing on her own. 02 Sat is at 91% upon entering room on 2lpm nasal cannula. Lung sounds reveal obvious loud crackles in all quadrants. Despite the lung sounds she doesn't seem to be struggling to breath or even seem short of breath. She is placed on monitor and BP is 67/44. A-Fib w/ RVR like they said at at rate of around 102. Sat. is at 92% on 2l.
I decided CPAP was not a good option. I have never used CPAP on a hypotensive patient before, and I am aware of the pre-load reducing effects by placing pressure on the vena cava. Due to the fact she was doing pretty good without it... I didn't want to risk it. On top of that I doubt she would of been cooperative with that huge mask on her face anyways. She did fine the entire 1.5 hr transport downtown, and required no intervention. She was alert the entire time (talking to the wall at some points), so I am pretty confident I made the right choice.
Just wondering if anyone has experience with CPAP in hypotensive patients, and how risky it really is. Would I of placed my patient in danger had she accepted the mask with that BP? Is there a certain limit on the BP where you decide CPAP is not a safe option?
Pt. has A-Fib with RVR at a rate of 100-110. Blood pressure is around 70/40 and has been hanging around that number consistently. Pt. has CHF and dementia. This patient also has a signed DNR.
Doctor says to me "Hey do you guys have CPAP? We wanted to put her on it but all ours are being used so we couldn't." I tell him we do and he says we need to use it on her.
Upon entering room and assessing patient it is obvious she is in late stage dementia, she will not answer questions appropriately and yells / groans any time she is touched. Daughter in room states this is her normal mentation. Otherwise she is awake, alert and breathing on her own. 02 Sat is at 91% upon entering room on 2lpm nasal cannula. Lung sounds reveal obvious loud crackles in all quadrants. Despite the lung sounds she doesn't seem to be struggling to breath or even seem short of breath. She is placed on monitor and BP is 67/44. A-Fib w/ RVR like they said at at rate of around 102. Sat. is at 92% on 2l.
I decided CPAP was not a good option. I have never used CPAP on a hypotensive patient before, and I am aware of the pre-load reducing effects by placing pressure on the vena cava. Due to the fact she was doing pretty good without it... I didn't want to risk it. On top of that I doubt she would of been cooperative with that huge mask on her face anyways. She did fine the entire 1.5 hr transport downtown, and required no intervention. She was alert the entire time (talking to the wall at some points), so I am pretty confident I made the right choice.
Just wondering if anyone has experience with CPAP in hypotensive patients, and how risky it really is. Would I of placed my patient in danger had she accepted the mask with that BP? Is there a certain limit on the BP where you decide CPAP is not a safe option?
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