Hello I have a question I can't seem to find a definitive answer to. For a patient complaining of chest pain would you administer a 500mL fluid bolus if protocols stated you only need to administer a bolus if signs of hypoperfusion are present? Assuming all vital signs are normal and the only abnormal things are the patient complaining of chest pain as well as having cool, pale, diaphoretic skin would administering a bolus be wrong or right? I know cool, pale, and diaphoretic skin is a sign of hypoperfusion, but with all stable vital signs I'm kind of on the fence here. Thanks in advance.
Fluid Bolus
- Thread starter khade
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The fluid is likely for to decrease the workload of the heart to maintain a normal blood pressure (vital signs would be normal or slightly elevated blood pressure with a rapid heart rate), or to increase their blood pressure if its low (vital signs would be obviously a low blood pressure). If they have a normal blood pressure and normal heart rate, there is no reason to administer it.
During a myocardial infarction, there is always hypoperfusion of an area of the heart that can lead to cell death because of a clot usually. Your protocols probably meant most of the body when it said hypoperfusion. I would look for other signs of hypoperfusion like an altered mental status/anxiety, elevated heart rate, or low blood pressure because considering administering fluids.
Cool, pale, diaphoresis is a common sign for hypoperfusion. It's caused by release of catecholamines (epinephrine, norepinephrine, and dopamine).
During a myocardial infarction, there is always hypoperfusion of an area of the heart that can lead to cell death because of a clot usually. Your protocols probably meant most of the body when it said hypoperfusion. I would look for other signs of hypoperfusion like an altered mental status/anxiety, elevated heart rate, or low blood pressure because considering administering fluids.
Cool, pale, diaphoresis is a common sign for hypoperfusion. It's caused by release of catecholamines (epinephrine, norepinephrine, and dopamine).
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teedubbyaw
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Not on a normotensive MI pt with no other presenting issues.
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Outside of RVI or an actual hypovolemic patient, I don't see much of a reason to administer a 500 mL bolus. Frank-Starling Law would be a good place to start for why you would administer a fluid bolus, and by extension, when.