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Tachycardia and Hypotension in a Patient on Anticoagulation
Case Study
A rapid response code was activated for a patient who developed decreased responsiveness along with tachycardia and hypotension. On arrival of the condition team, the patient was lying in bed, minimally responsive to painful stimuli. The patient was a 72-year-old female with a history of diabetes and coronary artery disease who was admitted to the hospital one day prior with unstable angina and was started on therapeutic dosing of enoxaparin (at 1 mg/kg twice a day). Her pain improved, and the plan was to continue her anticoagulation for a total of three days and to get a cardiac cath within one week in the outpatient setting. Overnight, the patient’s condition deteriorated, she became increasingly hypotensive, and the blood pressure had been unresponsive to 2 L of IV fluid boluses.
Vital Signs
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Temperature: 98.9 °F, axillary
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Blood Pressure: 80/50 mmHg
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Heart Rate: 120 beats per min, sinus tachycardia on telemonitor
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Respiratory Rate: 20 breaths per min
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Pulse Oximetry: 99% oxygen saturation on room air
Focused Physical Examination
The patient was an elderly female who was poorly responsive to verbal stimuli, but was moving her extremities in response to pain. Her respiratory and cardiovascular examination was otherwise unremarkable. A neurological exam was non-focal. No apparent signs of overt bleeding were identified. No excessive or unusual bruising was visible. Her extremities were cool to touch, with distal pulses weakly palpable.
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