Question

You are working in a pre-hospital setting and are called for a 40-year-old male who was the victim of a stabbing. The patient has a blood pressure of 87/50 and a heart rate of 130. There is a large amount of blood on the scene. After applying direct pressure to the wound on the patient's arm and stopping the bleeding, of the following what would be the best intervention to mitigate the patient's blood pressure?

A.Establish two large-bore IVs, and administer 2 liters of fluid

B. Establish an IV, and administer a norepinephrine drip at 0.1-2mcg/kg/min, titrated to effect

C. Establish an IV, and establish a dopamine drip to the patient at 5mcg/kg/min

D. Establish an IV, and administer fluid to keep the patient's BP at or near 90 systolic

Answer 1

The best intervention is to establish an IV and administer fluid to maintain the patient's systolic blood pressure around 90 mm Hg, which helps in restoring circulating volume and maintaining perfusion to vital organs.

Step-by-step explanation:

In a pre-hospital setting for a 40-year-old male victim of a stabbing with a blood pressure of 87/50 and a heart rate of 130, after applying direct pressure to stop the bleeding, the best intervention to mitigate the patient's low blood pressure would be to establish an IV and administer fluid to keep the patient's BP at or near 90 systolic. This intervention is prioritized to quickly restore circulating volume and maintain perfusion to vital organs. Using vasopressors like norepinephrine or dopamine could be considered later if fluid resuscitation alone is insufficient to maintain stable blood pressure. The immediate goal is to achieve and maintain a systolic blood pressure sufficient to ensure end-organ perfusion, particularly to the brain and heart. Other options might be considered, depending on the clinical situation and in-hospital care.