Abstract
The purpose of this case study is to help determine if emergency nursing education should include a focus on mean arterial pressure (MAP) and Pulse Pressure (PP) as part of their regular curriculum. We also considered if monitoring and trending BP, MAP and PP in patients who present with symptoms that may indicate a pulmonary and/or cardiac complaint, along with abnormal vital signs or abnormal lab values, would result in more timely intervention. Through this case study we hope to show that trending MAP may help identify early hypovolemic shock, severe sepsis and other significant life threatening conditions.
Highlights
The physician prescribed a weightbased dose of low molecular weight heparin (LMWH), IV crystalloid, and for Mr B to remain in the Emergency Department (ED) for a ventilation/ perfusion (VQ) scan in the morning
Given the complaint of increased back pain, the nurse determined the need to obtain bilateral Blood Pressure (BP) as she was concerned that Mr B could have an abdominal aortic aneurysm (AAA)
Mr B arrived at the designated hospital for vascular surgery in a pre-arrest condition, showing signs of decompensated shock, with a declining level of consciousness and a Heart Rate (HR) of 160 bpm
Summary
B was a 60-year-old male who presented to the Emergency Department (ED) of a Level Three trauma centre at 2200. His chief complaint at triage was shortness of breath and non-specific back pain. He stated that he had a history of chronic back pain from a work-related injury; this was “different pain”. Mr B denied other significant medical conditions, but 25 pack-year smoking history. He was given a Canadian Triage and Acuity Scale (CTAS) score of 3 and sent to the waiting room. The differential diagnoses considered by the ED physician included myocardial
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