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Should Increase In BP After Lap Band Replacement Worry Us ?
Question: 55 yo female , DOS for lap band placement. Pre-op VS BP 120/60, HR 70. RR 16, T 97.3, O2 sat. 97% RA.
Post op VS: BP 138/66, HR 78, RR 14, T 96.1, O2 sats 94% on 4L. I/O 1400 LR in, 175 urine out per catheter. EBL minimal. SCD's on.
Pt. arrives to floor A&O asking for ice chips and pain med. 30mg. Toradol IVP given. Stage 1 clear liquid bariatric diet started. She is resting w/o complaint is tired and wants to sleep.
current assessment: 45 cc XXXXXXX urine o/p for last 3 hours, pt. sleeping and appears comfortable. VS 151/69, HR 99, RR 16, O2 92% on 4 L.
I am concerned about increase in BP, HR, and O2 sats. I have HOB at 30degrees. Pt. is rousable, no pain or nausea.
Post op VS: BP 138/66, HR 78, RR 14, T 96.1, O2 sats 94% on 4L. I/O 1400 LR in, 175 urine out per catheter. EBL minimal. SCD's on.
Pt. arrives to floor A&O asking for ice chips and pain med. 30mg. Toradol IVP given. Stage 1 clear liquid bariatric diet started. She is resting w/o complaint is tired and wants to sleep.
current assessment: 45 cc XXXXXXX urine o/p for last 3 hours, pt. sleeping and appears comfortable. VS 151/69, HR 99, RR 16, O2 92% on 4 L.
I am concerned about increase in BP, HR, and O2 sats. I have HOB at 30degrees. Pt. is rousable, no pain or nausea.
Hello and thanks for the query.
I understand your concerns in this patient and a few things should be considered as far as the heart rate and vitals are concerned. Another important thing to follow is the urine output. If she is fluid overloaded that could generate a tachycardia as well as a drop in oxygen sats and an increase in blood pressure. Assuming her heart function was normal preop then she should be able to mobilize any excess fluid without a problem and her vitals should improve. A BNP may be helpful in this setting. If it is > 150 then you might consider diuresis.
We can't ignore the risk of PE/DVT. D-Dimer will not be of help in the setting of surgery. You could ultrasound her legs to rule out DVT as well. A chest xray would not be unreasonable in the setting of relative hypoxia in addition to an both legs - this is critical.
Thanks again for submitting your query. If you have any additional concerns regarding this case please do not hesitate to ask.
Sincerely,
Dr. Galamaga
I understand your concerns in this patient and a few things should be considered as far as the heart rate and vitals are concerned. Another important thing to follow is the urine output. If she is fluid overloaded that could generate a tachycardia as well as a drop in oxygen sats and an increase in blood pressure. Assuming her heart function was normal preop then she should be able to mobilize any excess fluid without a problem and her vitals should improve. A BNP may be helpful in this setting. If it is > 150 then you might consider diuresis.
We can't ignore the risk of PE/DVT. D-Dimer will not be of help in the setting of surgery. You could ultrasound her legs to rule out DVT as well. A chest xray would not be unreasonable in the setting of relative hypoxia in addition to an both legs - this is critical.
Thanks again for submitting your query. If you have any additional concerns regarding this case please do not hesitate to ask.
Sincerely,
Dr. Galamaga
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Above answer was peer-reviewed by :
Dr. Prasad
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