Last night while playing wallyball, one of the players collapsed. We later learned that he had (as many of us suspected) a heart attack. He was taken tot he hospital by paramedics, but not after they did a few things on-site.
One of the things they determined was that his blood pressure was low. I am assuming this is because the heart muscles were starved of oxygen, and thus operating very weakly. To increase the blood pressure, they administered fluids in an IV.
I don’t understand why they did this. I understand that adding fluid to a closed system will increase the pressure within it, but I don’t understand how this (to me) artificial inflation of the blood pressure would have any real effect on the condition of the patient.
Can someone explain it to me?
Oh, and this dude was 40, no history of heart problems, played racquetball and wallyball all the time. Everyone was shocked (as everyone often is when something liek this happens). It was a wake up call for me to schedule that yearly physical that I’ve been putting off for the past 7 years.
I think you answered your own question but just don’t believe it.
However you raise the blood pressure, it means that there will be more pressure in the system and, in particular, more pressure to “force” the blood into all areas. As you said, his heart muscles were starved of oxygen. If the BP goes too low, those muscles will get even more starved since there’s not enough pressure to push the blood (and hence oxygen) into them.
A simpler example may be with the brain. If the pressure driving blood into the brain is too low, it may get so low as to not to be forceful or effective enough to push blood into the brain. The result will be a stroke.
Of course, there is a potential downside to raising the blood pressure by filling the system with extra fluids. You may add too much fluid and thereby cause the heart to be unable to meet the additional demand needed to push around this increased load. If that happens it’s called heart failure and will lead to a very serious condition called pulmonary edema.
Another downside is that as the blood pressure increases, the demand on the heart to deal with that increased pressure also increases. This means the heart will require more oxygen (i.e. to do more work). If the blood vessels delivering blood (and hence oxygen) to the heart itself are narrowed or blocked, the result can be a heart attack.
Sorry to hear about your friend, hope hes doing well.
One big thing is, if he still has a decent blood pressure, they will want to get a line in for venous acces for quick administrations of drugs. Paramadics carry a variety of drugs that can help supress various arrythmias and or help balance certain other blood chemistry problems. In addition, many people who collapse under physical duress who seem otherwise healthy are dehydrated.
So in a nutshell, just adding fluid can help, if they need some kind of IV medication, it can now be injected into that same line or added to the IV bag if appropriate.
There are a couple reasons why there would be fluids running on the pt. In a lot of places, everyone that gets an IV gets a bag of fluids hung. It’s just a question of what rate it’s administered at. Also, if you give any medications IV, you need to run fluids to make sure the meds circulate. Nitroglycerin, which is commonly given to patients with cardiac-type chest pain can cause hypotension. If you’ve already got an IV, you can counteract it with fluids.
Also, in myocardial infarction with right ventricular involvement, the patient will benefit from fluid administration. The RVI will reduce preload on the left ventricle, which can exacerbate ischemia and hypotension.
St. Urho
Paramedic
There are a couple reasons why there would be fluids running on the pt. In a lot of places, everyone that gets an IV gets a bag of fluids hung. It’s just a question of what rate it’s administered at. Also, if you give any medications IV, you need to run fluids to make sure the meds circulate. Nitroglycerin, which is commonly given to patients with cardiac-type chest pain can cause hypotension. If you’ve already got an IV, you can counteract it with fluids.
Also, in myocardial infarction with right ventricular involvement, the patient will benefit from fluid administration. The RVI will reduce preload on the left ventricle, which can exacerbate ischemia and hypotension.
St. Urho
Paramedic
Okay, there are many reasons that fluid is given to someone with hypotension. Simple dehydration can cause hypotension, and replacing the fluid that has been lost can solve this.
Your heart is a muscle, as we all know. As your heart becomes weaker due to myocardial infarction it is less able to push blood around your body. As Urho earlier eluded this can reduce the amount of blood returning to the heart, effectively un-priming the pump. Adding fluid can help solve this.
More importantly, by adding additional fluid to the system, you cause the heart to stretch. This stretching causes the heart to contract more forcefully, increasing your cardiac output, and there for your blood pressure.
<nitpick> Also, not everyone that gets an IV gets fluids hung. It is also common to place a saline lock on the IV cath, so there is access for giving medicine, but no significant amount of fluid is given. If someone still has a pulse, they can likely circulate the medicine on their own.
i should also note that administration of iv fluids, called a fluid challenge in the OP example, is not a begin intervention. fluid overload can lead to pulmonary edema and heart failure.