The practical and scientific approach for Hypotensive patient

Blood pressure (BP) = Cardiac output (CO) x systematic vascular resistance (SVR)
	IS CO REDUCED?
	Yes	No
BP	90/70 mm Hg	90/40 mm Hg
Skin	Cool, blue	Warm, pink
Nail bed return	Slow	Rapid
Heart sounds	Muffled	Crisp
History/lab	Hypervolemic or cardiogenic etiology	or WBC and/or temperature
		Source of infection
		Immune compromise
		Severe liver disease
Working diagnosis	See next question	Septic shock/endotoxemia
	IS THE HEART TOO FULL?
	Yes	No
Presentation	Angina, dyspnea	Hemorrhage, dehydration
Signs	Cardiomegaly	Dry mucous membranes
	Extra heart sounds	tissue turgor
	JVP	Stool, gastric blood
Lab	ECG, x-ray	hematocrit
	Echocardiogram	BUN/creatinine
Working diagnosis	Cardiogenic shock	Hypovolemic shock
	WHAT DOES NOT FIT?
	Cardiac tamponade	Anaphylaxis
	Acute pulmonary hypertension	Spinal shock
	Right ventricular infarction	Adrenal insufficiency
	Overlapping multiple etiologies

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power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...

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