Hemodynamically Unstable

Symptoms

1. Dizziness or Syncope:
   • Due to decreased cerebral perfusion.
2. Cold, Clammy Skin:
   • Suggests peripheral vasoconstriction and hypovolemia.
3. Altered Mental Status:
   • Confusion or lethargy from cerebral hypoperfusion.

   • Vital Signs:

     1. Hypotension:
        • Systolic blood pressure <90 mmHg or a significant drop from the patient's baseline.
     2. Tachycardia:
        • Heart rate >100 beats per minute as a compensatory response to blood loss.
     3. Orthostatic Hypotension:
        • A drop in systolic BP of ≥20 mmHg or diastolic BP of ≥10 mmHg upon standing.
     4. Narrowed Pulse Pressure:
        • Indicates reduced stroke volume.

Physical Exam Findings:

1. Pallor:
   • Indicative of anemia and poor perfusion.
2. Delayed Capillary Refill:
   • Capillary refill time >2 seconds.
3. Jugular Venous Collapse:
   • May indicate significant intravascular volume depletion.

Laboratory Findings Suggestive of Instability:

1. Hemoglobin Drop:
   • Indicates ongoing blood loss, though it may lag behind acute losses.
2. Elevated Blood Urea Nitrogen (BUN):
   • Often disproportionate to creatinine due to increased protein breakdown from blood in the gastrointestinal tract.

Additional Indicators:

1. Decreased Urine Output:
   • <0.5 mL/kg/hour, reflecting hypoperfusion to the kidneys.
2. Evidence of Shock:
   • Clinical signs consistent with hypovolemic or hemorrhagic shock.

Management

 

 

 

Management and Determining the Cause

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