Tachycardia How To Keep Your Patient Alive in The Middle of The Night
Tachycardia How To Keep Your Patient Alive in The Middle of The Night
Tachycardia How To Keep Your Patient Alive in The Middle of The Night
• Febrile • Mental status most important to start • Fluid balance for the shift
• Tachypneic • Any cardiac monitor abnormalities
• Complaining of pain • Comfortable
• Hypotensive • In distress Chart review!
• Sleepy/asleep • Is this new for the patient
• What changes were made today
• Unresponsive • Recent medications
(You would hope this wouldn’t just be a page…)
• Capillary refill
• Pulses
• respiratory status
• What is the RNs overall perception of the
patient
Grab your
P waves? PALS card and
call for help!
2. Make sure patient is stable: what is the
hemodynamic status?
Chart review…
To bolus or not to bolus?
Labs?
Imaging?
Other diagnostic studies?
Meds or other interventions?
Re-examination?
2nd and 3rd 20 cc/kg boluses given= 60 cc/kg total for HR up to 170s
FEN: Electrolytes normal with anion gap 17 and BD 8; net negative fluid
balance prior to boluses
Next Steps GI: Abdominal girth slightly increased. LFTs normal. KUB, abdominal US
normal
over the next 6ish hours RENAL: BUN/Cr wnl and stable; normal UOP. Abscess improving in size on
imaging
• CBC stable
• CRP 1.8 (decreased from two days prior)
• Broadened antibiotic coverage
Decided to send
Huddled with
patient to the PICU
Fellow contacted PICU contacted bedside RN and
with significantly
charge RN
elevated lactate
CV: Trended lactates
NEURO: No concerns
MRI Abd/Pelvis:
2. No new abnormality.
Before coming back to the floor….
Worse abdominal distention and increased girth with increased WOB. Lactate 4.75.6. HR 150s
CXR normal
KUB IMPRESSION:
Findings compatible with marked distention of the stomach,
with ingested material and small amounts of gas.
Gastric distention was also noted on 10/20,
but was not noted on abdominal MRI dated 10/25/.
The findings raise the possibility of intermittent gastroparesis.
The next day…
Brenna Benson’s personal experiences on the Lahey team (whatever that’s worth)
UptoDate
PALS
AHA guidelines