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25 Minutes 225 Megabytes.epub

25 Minutes 225 Megabytes.epub


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25 Minutes 225 Megabytes.epub

fluid challenge is used to determine the adequacy of fluid administration. the usual initial step of fluid challenge is to administer approximately 1 l of normal saline in 10 minutes and observe the resulting bp changes.14 if the patient has an intravascular volume deficit, then the fluid is administered at a slower rate in order to minimize the risk of hypotension. to prevent volume overload, the fluid should be discontinued if the patient is hypotensive at any point during the fluid challenge, despite adequate intravenous vasopressor therapy. a final bolus may be used if the patient is still hypotensive after the slow infusion. a final bolus of 10 to 20 ml/kg of normal saline is associated with a mild reduction in blood pressure. a final bolus of 20 to 40 ml/kg of normal saline is associated with a more dramatic reduction in blood pressure. a final bolus of 10 ml/kg of normal saline is associated with an increase in heart rate. a final bolus of 40 ml/kg of normal saline is associated with a decrease in heart rate. hypotension that occurs in the setting of fluid infusion should be considered to be a potentially reversible form of treatment-related hypotension, and a patient should be closely monitored after volume replacement is initiated.

beta blockers: the goal of therapy in hypertensive emergencies is to lower the blood pressure. beta blockers have been shown to be the most effective antihypertensive agents in this setting. in addition, they can be used as first-line therapy in noncardiac hypertensive emergencies, due to their role in treating the underlying cause of high blood pressure. the initial dose is 0.5 to 1 mg/kg/dose, titrated every 5 to 10 minutes. if the agent is used, it should be administered at a slow infusion rate and then be discontinued when the desired effect is achieved.

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