Question: Example: A patient presents generally unwell, lightheaded and feels like their heart is beating fast, not an unusual call for any paramedic. On exam the patient has a pulse of 130-150 BPM, sinus tach to match on the monitor and BP is 100-110 systolic. Would it not be safe to assume that the BP is being maintained by the HR?

The question: Could this patient not benefit from a one time fluid bolus/challenge of 250ml to see if it decreases the HR decreasing cardiac demand and maintain the BP thus being beneficial for the patients overall condition? I realize that the IV and fluid therapy directive is for a BP less that 90 Systolic and is to ensure that a patient has an adequate perfusion or actual/potential need for medication, however would this not fall under the fluid therapy part of the IV and fluid therapy directive?

 Thanks for the question. Your description of the physiology is quite accurate and well thought out! You are correct, it is absolutely possible that a dehydrated and exhausted patient or a hypovolemic patient could have a resting tachycardia of 130-150 and is maintaining a blood pressure of 100-110mmHG systolic which in fact may be actually quite low for them. The other possibility is that you may be confronted with a patient who is suffering from another condition causing sinus tachycardia (pain, hypoxia, anxiety, drug use etc€¦) and this blood pressure is actually their normal value.

When designing the medical directives, we needed to have a "line in the sand" where the fluid bolus would be indicated. Paramedics like concrete numbers and indications to treat, so hypotension was defined as SBP < 90mmHG for the purposes of the medical directives to accomplish this goal.

So, to answer your question, no, this would not fall under the fluid therapy part of the IV and fluid therapy directive since the patient is not hypotensive. However, if you feel that (as in the first scenario above) the patient remains significantly dehydrated or hypovolemic, you are welcome to patch and review the case with the BHP.

Cardiac/Circulation,Intravenous and Fluid Therapy

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