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Hypotension accompanies many of the critical illnesses we see in the emergency department. Sometimes it’s there when the patient walks in the door. Other times, it catches us by surprise (when it really shouldn’t).
Rae S. - April 7, 2016 12:41 PM
Would you hesitate using the phenylephrine or epinephrin push dose for someone tachycardic in Afib/Flutter, hypotensive, but also some signs of cardiac ischemia or known coronary artery disease? Do you think the benefit of improved coronary perfusion with a better pressure and slower pulse would outweigh any increase in cardiac muscle demand? Would cardioversion be preferential in this situation? Thank you.
James M. - April 10, 2016 11:36 AM
I think it would be a tough sell to to give epi to a patient with a heart rate of 180. Especially if they didn't listen to your pod cast.
James M. - April 13, 2016 6:41 AM
I don't understand the rationale for giving 2grams of calcium prior to the Diltiazem. I am not familiar with this.
Tim L., M.D. - April 20, 2016 6:28 AM
Hi
I understand your rational for the approach you take with the hypotensive SVT patient . I would take a simpler approach being simple minded to begin with . Start fluids but would go straight to cardioversion . Would use low dose ketamine for sedation and analgesia . Thoughts ?
Thanks
Tim LaBelle
brendan c. - April 21, 2016 6:05 AM
Response to James M. :
People used to give calcium with verapamil to mitigate the hypotensive effects while still providing rate control. Diltiazem is a different class of calcium channel blocker and there is less hypotension, so the calcium is not routinely used.