Altered calling criteria Flashcards
An 80 year old male is in hospital recovering from a skin graft for a scan SCC. He has a background history of hypertension, end stage coronary artery disease, HFpEF, obesity, T2DM and CKD. His BP is usually around 100mmHg systolic and the ward staff are requesting a change in emergency call criteria. How would you manage this?
Impression
In this 80yo man with significant number of medical co-morbidities with consistently low blood pressure is a common scenario.
DDx
- Common causes: blood loss, dehydration, medications (ACEi, anaesthetics), postural BP
- Red flags: ACS, PE, sepsis
Goals
- Undertake thorough Hx/Ex/Ix of patient to rule out red flag differentials and gain understanding of clinical presentation
- review obs and medication charts
- institute appropriate management according to likely cause, if medically clear discuss with senior team member
Altered calling criteria – History
History
- Review patient notes, identify any previous review for low BP, findings, and management plans instituted
- Sx: light headedness, headache, falls/collapse/syncope,, chest pain, palpitations, SOB, N/V,
- Systems review for infection
- Medications review
- SNAP
Altered calling criteria – Examination
Examination
- Review vitals
- Repeat any relevant examination (Resp, Cardiac)
- Hydration status assessment
- Assess surgical site for signs of infection
Altered calling criteria – Investigations
Investigations
- Bedside: postural BPs, ECG, urinalysis
- Bloods: Only if relevant, check EMR
- Imaging: only if indicated for new pathology
Altered calling criteria – Management
Management
Definitive mx for any underlying causes identified:
- ceasing injurious medications
- fluid bolus if dry and not CI in renal disease, etc
- ensure
Otherwise
- discuss with reg re altering calling criteria to BP <100mmHg for this patient, pending being medically cleared
- communicate with staff re changes, keep regular obs initially after changing criteria
