I’ve been an RN for 4 years but started working in the MICU around 6 months ago. I’ve learned so much in those 6 months and being in the ICU has made me hungry to broaden my knowledge base as a RN.
I had a patient last night who had me really thinking hard about what exactly was going on with them. Here’s a short background. I’ve changed some patient info for privacy reasons.
19 yo admitted for severe sepsis and pneumonia. Has a history of necrotic transverse myelitis as an infant leading to quadriplegia, severe developmental delay, seizures, tracheostomy, and ventilator dependence. No other pertinent medical history.
The patient’s heart rate would fluctuate between a SVT rhythm in the 160s and NSR in the 70s. BP would also fluctuate as well with their MAPs ranging from the 40s up to 100. The patient’s physical exam was unremarkable. Labs were fairly normal and other diagnostic test were negative.
My thought process was the patient is septic which would explain his tachycardia and hypotension. The patient’s tachycardia and hypotension did somewhat respond to fluid boluses but not as well as I’d like. However, I couldn’t explain why his HR and BP were fluctuating like they were which leads me back to my original question.
How do spinal cord injuries affect hemodynamics such as HR and BP?
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