Question: I was recently on a call with a patient presenting with a tachy rhythm of 157 and his blood pressure was 74/42. I proceeded to start a line and was going to bolus but subsequent pressures were above 90 systolic. Would it have been reasonable to not bolus due to the fact that this patient most likely had a decreased BP due to the Fast heart rate and not because of a fluid deficit?
Great question. The patient in question would most likely benefit from the bolus assuming they were not in pulmonary edema. The most common reasons for the vital signs described would be dehydration, sepsis or rapid atrial fibrillation. The initial Emergency Department treatment of all of these conditions is an IV Bolus.