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Intravenous fluids will be needed to rehydrate the patient: these should be commenced with caution as the patient may have underpinning heart failure. 12). 12 Recording postural blood pressures Rationale: Under normal conditions autonomic reflexes stabilize an individual’s blood pressure from the lying to sitting/standing positions. This can be seen as the initiation of quick response mediators that result in peripheral vasoconstriction and shunting of blood into the main circulation. When there is an established loss of circulating volume in the peripheries, this mechanism fails and a fall in blood pressure results, therefore, the recording of a postural blood pressure is an excellent eliminative tool to the practitioner suspecting a patient to be in the early stages of shock.

INITIAL ASSESSMENT: PRIORITIZING CARE • • • • 23 If actual or potential airway compromise exists, administer adrenaline. ). 6): if inadequate, administer adrenaline and gain IV access. Secondary drugs include: anti-histamines, which will prevent further deterioration; steroids to reduce inflammation (although they take 4–6 hours to work); a beta-agonist to reduce smooth muscle contraction within the bronchioles; and IV fluids to restore circulation. The Resuscitation Council (UK) has published specific guidelines on anaphylaxis (RCUK 2006).

2). This is very important for establishing heart blocks. For example, if the P-R interval is prolonged, this signifies a delay in the conduction sequence. In contrast, if the P-R interval is short, an underlying pathology like the WolffParkinson-White syndrome may be present. Is the QRS complex width normal? Ventricular conduction is reflected by the QRS complex and is larger than the P wave, which represents the atrial contraction. This is due to two factors: first, the relative size of the ventricles in comparison to the atria and, second, the anatomical origin of the electrical stimulus.

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A.P.I. Textbook of Medicine by Sainani G. (ed.)

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