Question: I am wondering if it is acceptable to initiate a bolus for hypotension based on "estimated" blood pressures. I.e. you are unable to obtain a BP through auscultation and the patient has no palpable radial pulses. We have been taught that you can estimate a patient's blood pressure to be 80 systolic or less with the absence of palpable radial pulses. So, can I treat a patient with a bolus, based on estimated BP's and in conjunction with other symptoms, or do I need an actual and specific number. Thanks in advance.

 Great question. The key here is that the patient has no obtainable blood pressure and no palpable radial pulses. Most likely this patient is hypotensive and requires a fluid bolus so the answer is yes. In fact, this patient may be about to arrest and insisting on documenting a blood pressure of 50 systolic in order to qualify for a fluid bolus may be unsafe. Again- the key here is that the blood pressure is so low, it cannot be obtained.

With that said, don't be so confident that the presence of a radial pulse equates to a blood pressure of 80 systolic. We know this is what is continually taught, but unfortunately this is just not true. Many of us have been in clinical situations where the blood pressure is far below 80 and a radial pulse can still be felt, so please be cautious with that assumption.

Cardiac/Circulation,Intravenous and Fluid Therapy

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