2007-09-24

Hypotension -- a Post-AVG-Revision (to be continued)

This lady has a Left Arm AVG.
22/09/2007:
AVG blocked on the normal haemodialysis day, came to ward through ED, had anti-hyperkalemia therapy(resonium 30g, IV 50% Dextrose 50mls and IV Actrapid insulin 10units) and fasted overnight.
23/09/2007:
AVG revision in the morning, finished at 12pm. Then, start to dialysis. in the end of the dialysis, graft started to bleed a huge amount, spent 30mins pressure, bleeding stopped, but AVG stopped working.
1730, pt went to OT for urgent AVG revision again.
1930, back from recovery, had N/S 600mls in recovery. AVG bruit but frank thrill. BP(110/50mmHg, pt asymptomatic) low range, pt's normal BP around 120~130/60~70mmHg, MO ordered to recheck in 1/2hr.
2000, BP still low (104/50mmHg). MO ordered Gelofusine 500mls over 2hrs.
2030, Recheck BP, still low, AVG bruit but still frank trilll. Increase rate to 500mls over 1 hrs as MO ordered.
2100, 300mls Jelofusion infused. BP even lower (90/40mmHg, still asymptomatic), AVG bruit but very frank thrill....MO, close monitor AVG and BP, review again when Jelofusion finishing. No bleeding since back from recovery.

?Problem: Vascular Colloid Pressure decreased due to blood loss from 2*OT and post dialysis even N/S 600mls. But why Gelofusine as a IV colloids didnt build up BP after infusion?
?Solution:

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