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May 4, 2021
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Hi, yesterday I was in a GI cholonoscopy and after the insertion of the camera, the pt BP dropped. My attending asked me why the diastolic was so decreased. His answer was because diast BP is equal to preload and the patient “needed volume”.
Is this concept right? I searched in the web and Guyton but could not find this correlation
Tks
 
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Planktonmd

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Hi, yesterday I was in a GI cholonoscopy and after the insertion of the camera, the pt BP dropped. My attending asked me why the diastolic was so decreased. His answer was because diast BP is equal to preload and the patient “needed volume”.
Is this concept right? I searched in the web and Guyton but could not find this correlation
Tks
How about a vagal response to dilating the colon?
 
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ethilo

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He's probably trying to drive home that you should remember they get a bowel prep that makes them dry and easily get hypotensive. Whether that is diastolic blood pressure related I wouldn't take that leap myself.
 
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Hoya11

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Hi, yesterday I was in a GI cholonoscopy and after the insertion of the camera, the pt BP dropped. My attending asked me why the diastolic was so decreased. His answer was because diast BP is equal to preload and the patient “needed volume”.
Is this concept right? I searched in the web and Guyton but could not find this correlation
Tks
what pressure does the cuff measure?
 
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Unless you have an a line the map is all you measure. The automated cuff gives you a systolic and diastolic pressure that is calculated based on a proprietary algorithm.
 
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Hoya11

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Unless you have an a line the map is all you measure. The automated cuff gives you a systolic and diastolic pressure that is calculated based on a proprietary algorithm.
right - so the true diastolic bp was not even known
 
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vector2

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Hi, yesterday I was in a GI cholonoscopy and after the insertion of the camera, the pt BP dropped. My attending asked me why the diastolic was so decreased. His answer was because diast BP is equal to preload and the patient “needed volume”.
Is this concept right? I searched in the web and Guyton but could not find this correlation
Tks
Saying aortic diastolic pressure is a reflection of preload is a gross oversimplification. More generally, arterial blood pressure is a function of arterial compliance and stroke volume, and there are many factors that go into determining a particular pt's systolic, diastolic, pulse pressure, and mean arterial pressure.

Pointing to a low indirectly calculated diastolic on a non-invasive oscillometric cuff and then proclaiming the pt must be volume-down after induction for a colonoscopy is pure nonsense.
 
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DrOwnage

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After an attending once told me that patients "could still larygospasm when they're paralyzed because its a different muscle" I learned to start self-confirming stuff that sounded like horsecrap. Misinformation is worse than no information. Don't just blindly believe something someone says because they are in a position above you, especially your attending. After you have exhausted other routes and cannot find said explanation, post it here and usually someone knows.
 
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