The OBHG Companion Document weighs in on this and states for the Cardiac Ischemia Medical Directive that, “if a patient’s vital signs fall outside the medical directive’s parameters (i.e.: hypotension), the patient can no longer receive that medication, even if the patient’s vital signs return to acceptable ranges”.
Other situations are less clear. Medical Council has discussed this and agreed upon the following:
Iatrogenically caused: No
If the hypotension is after receiving a medication (iatrogenically caused) then they should not receive that medication again, even if the blood pressure normalizes, with or without IV bolus therapy. Since it has caused a negative response, it should be withheld to prevent the same response occurring with further administration.
Example: A patient becomes hypotensive after receiving fentanyl for analgesia. They should NOT receive further fentanyl, even if their BP normalizes (with or without IV fluid bolus therapy).
Patient requires Fluid bolus to normalize BP: No
If the patient requires a fluid bolus to normalize their blood pressure, they should not receive a mediation that could again decrease their blood pressure. These patients have demonstrated their hemodynamics are tenuous with little reserve for a medication that could then decrease their BP again.
Example: A patient is initially hypotensive, but their BP normalizes with IV fluid bolus. They should NOT be considered for a medication that lists Normotension as a Condition.
Patient’s BP returns to normotensive without intervention: YES
If the patient’s BP returns to normal without intervention, then it is reasonable to administer medication whose Condition is “Normotension”.
Example: A patient is initially hypotensive, but their BP normalizes without IV fluid bolus. They CAN be considered for a medication that lists Normotension as a Condition.
As always, if there is an extenuating circumstance in which critical patient needs are required that fall outside this instruction, a BHP patch can be considered.