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Inverse relationship between blood volume and blood pressure.

Article Excerpt
Patient Profile

EG is a 48-year old, Hispanic female with end stage renal disease (ESRD), secondary to hypertension. She has been on hemodialysis for 15 years and has a history of atherosclerotic heart disease, atrial fibrillation, and multiple infections. She had diffuse leg and hip pain for which she was treated with a T9 fusion. This led to the development of a perivertebral abscess causing paraplegia and subsequent Stage IV decubiti. In addition, she had a left subclavian vein stenosis as sequela of a peripherally inserted central catheter (PICC).

EG was admitted to the hospital on June 18, 2002 for wound management of her abscess and for skin grafting. She subsequently became hypotensive due to sepsis and she required intubation from which she was later successfully weaned. Her systolic blood pressures ranged from 60-110 mmHg.

Six weeks later, EG was transferred to another facility for aggressive management of her Stage IV ulcer. A few hours after transfer, she became bradycardic with decreased respiratory rate. After atropine administration, she went into sinus tachycardia and then into ventricular tachycardia, which resolved with cardiac thump and intravenous (IV) amiodarone. She required intubation, and was admitted to the intenive care unit (ICU).

After 2 weeks she continued to be ventilator dependent...