Following angioplasty, a patient develops the following: hematuria, hypotension, tachycardia, a drop in hemoglobin and hematocrit, and a decrease in oxygen saturation. What is most likely the cause for these symptoms?
1. Reaction to vasovagal stimulation
2. Myocardial ischemia
3. Peripheral emboli distal to the insertion site
4. Over-anticoagulation
4
Rationale 1: Vasovagal symptoms would include decreasing heart rate and not impact the H/H or O2 saturation levels. Blood pressure may be down and fainting usually occurs with orthostatic positioning.
Rationale 2: Ischemia may cause BP and HR symptoms with changes in O2 saturation but not the decline in H/H.
Rationale 3: Emboli distal to the insertion site will not alter the BP, HR, H/H, or O2 saturation. The pulses will be diminished or absent depending on the degree of obstruction or the size of thrombi.
Rationale 4: The symptoms are a result of over-anticoagulation, which results in blood loss through the kidneys and other organs, resulting in a declining hemoglobin/hematocrit (H/H). The decrease of RBCs results in the compensation mechanism for shock by increasing the HR when compensating for the tissue hypoxia present from the lack of RBCs. Decreased perfusion and O2 saturation in the tissues will be present.
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