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<< Symptomatic Hypotension: ED Stabilization And The Emerging Role Of Sonography

Cost- And Time-Effective Strategies In The Workup Of Unexplained Hypotension

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Cost- And Time-Effective Strategies In The Workup Of Unexplained Hypotension

Cost- And Time-Effective Strategies In The Workup Of Unexplained Hypotension

1. Keep bedside ultrasound available to answer focused questions on global heart function and volume status. Signs of vascular catastrophes, massive pulmonary embolism, and tension pneumothorax can also be sought without interrupting resuscitation efforts.

  • Don't use the CXR to rule out aortic dissection, pericardial effusion/tamponade, or cardiomyopathy based on a mere silhouette.
  • Don't wait for the CT and the serum creatinine to determine if a high suspicion AAA is present orabsent.

2. Assess cardiac dynamics and CVP estimates before, during, and after fluid and catecholamine support. Well designed studies support the use of goaldirected echocardiography in the hypotensive ED
patient.

3. Use crystalloid solutions for fluid resuscitation. No outcome improvements are in the current literature that justify the use of more expensive colloidal solutions in the USA. Goals may include: CVP improvement, cardiac index improvement, adequate urine output, and lactate clearance.

4. Organ hypoperfusion can be occult; aggressively seek to get clues using noninvasive monitoring such as tissue oxygen saturation, central venous oximetry, and lactate levels.

5. Use hypotension as a threshold point, not as a goal. Address multiple factors that may impact hypotension and, more importantly, organ hypoperfusion.

Publication Information
Authors

Anthony J. Weekes; Ryan J. Zapata; Antonio Napolitano

Publication Date

November 1, 2007

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