I called up the nurse and held her antihypertensives.
My pager went off an hour later. Riva's BP on recheck is 68/38. Please advise.
I stared at my patient's LVEF of 35% and then told the nurse to give a 500cc bolus, and reassess as soon as it was done.
BP 64/38.
Miss Riva stared at me in bewilderment every time I came in. I feel fine, she kept insisting. But the rapid response nurse kept taking her blood pressure. And I kept staring at her med list and her EKGs, chest xrays, CTs, and echos, trying to figure out what I was missing.
After six hours of continuous vitals monitoring and 3L of fluids, my senior resident finally decided that we just didn't know what to do, and sent Ms. Riva down to the medicine ICU.
I feel like a failure. I just can't figure out what we could have possibly missed.
