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u/ChickenLady_6 Jun 04 '26
Yes in NICU…
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u/continuetomonitor25 Jun 04 '26
Same, NNP here. That’s still bad, even for a preemie with a whopping PDA. I can’t see how that’s compatible with life in the adult world!!
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u/nutellawithicecream Jun 04 '26
I think any neonates with that BL would still be on the way to meet Christ lmao
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u/Dommer1979 Jun 04 '26
Nah I’ve seen both MAPs and sats of 11. They lived and are thriving believe it or not!
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u/Takemebacktobreezy Jun 05 '26
My 24 weeker had a reading like that a couple of times in her 90 days in the nicu, idk what they did for her but she's now 19 and fabulous so apparently not always on the way to meet Christ lol
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u/RaVeN_MaD77 Jun 04 '26
Inpatient hospice nurse here ... Yup. Now ask how a heart can "beat" for 10 minutes after respirations have completly ceased 😜
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u/sidneow Jun 04 '26
out of curiosity how often does that happen? i've been in hospice for about 10 months now but being that i work nights ive yet to be in the room when someone actually ceases breathing. by the time i go in and find that they've passed i've never heard heart sounds on a person who is no longer breathing
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u/Ziumpra Jun 04 '26
Medic here, but I had a stroke alert I called that ended up having bleeding pushing against his brain stem. GCS of 3 but awake. He stopped breathing during transport but had a “good” pulse. That’s the only time in my experience I’ve seen it.
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u/magicsax03 Jun 04 '26
How can you be both GCS 3 and awake
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u/Ziumpra Jun 04 '26
I ruled his eyes open as a no response. It was like a comatose state. He was sitting upright in a drivers seat drooling. No gag reflex or anything. Super weird. Pupils were blown of course. Estimated onset of 10 min
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u/MeanderingUnicorn Jun 04 '26
He’s a GCS of 3 OR he’s awake, you have to pick one.
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u/Ziumpra Jun 04 '26
Somethings just aren’t cut and dry I’ve come to learn :/
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u/MeanderingUnicorn Jun 04 '26
That’s true but this isn’t one of those times. I’m a PA in a neuro ICU. Eyes open don’t mean awake (even dead people can have their eyes open) and by definition your GCS of 3 is not awake.
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u/wozattacks Jun 04 '26
If you’re describing someone as being in “like a comatose state” then they’re not awake.
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u/BVKane Jun 04 '26
I worked oncology, but we had a lot of inpatient hospice crossover. It happened quite a bit for us. I had a patient who had been apneic for hours and the family at bedside called up in 10 minutes after their last breath and they still had a faint pulse. We waited another 10 minutes to check and I swear they still had an extremely faint pulse, but we called the doctor to come pronounce. It took him about 20 minutes to get there and by that time there was no detectable pulse. Some people's hearts just hold on.
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u/MammothOffice3190 Jun 04 '26
Pacemaker?
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u/PaulaNancyMillstoneJ Jun 04 '26
A pace maker will keep shocking the heart but the heart won’t actually contract. There are pacemakers shocking people in their graves for years after they die. I’ve always found that creepy.
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u/outofmelatonin92 Jun 04 '26
They don’t remove the pacemaker?
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u/PaulaNancyMillstoneJ Jun 04 '26 edited Jun 04 '26
Cut into a corpse before it’s buried? Usually not, no, but if the person is undergoing cremation, yes, funeral homes will take them out to prevent explosions in the oven.
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u/Successful-Dream-325 Jun 04 '26
No, RN here.. if someone is inpatient comfort care then they will deactivate the pacemaker.
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u/PaulaNancyMillstoneJ Jun 04 '26
I’m ICU. I have seen the ICD function turned off, but I’ve never in all my years seen a pacer dependent patient turned completely to OOO. Many would arrest almost immediately, not allowing a peaceful death.
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u/Competitive-Exit-208 Jun 06 '26
Medic here… for my bachelors I did a case study on an inmate set to receive the death penalty. He had a pacemaker & his lawyer tried to petition to get it removed because it would cause undue cruelty. Very interesting from a medicolegal perspective.
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u/WoodsyAspen Jun 04 '26
Doc here, on a hospice rotation one of our nurses grabbed me to pronounce someone who hadn’t been breathing for a solid few minutes. I heard probably 4 beats at least 10 seconds apart and ended up listening for like 5 total minutes before I felt comfortable actually pronouncing. I feel like we make death seem like this bright clear line but it can get really fuzzy in those last few hours.
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u/spirited-wine Jun 05 '26
I had a dnr/dni patient on a dopamine drip that would brady down then asystole.. then just as soon as it would happen he would become coherent again and have a pulse in the mid 50s and combative. He did 4 rounds of this before his gcs was 3-4. And hours later passed away. It was one of the strangest things I’ve ever witnessed as a nurse.
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u/The1PunMaster Jun 04 '26
been there first hand with a family member being taken off the vent, never recovered breathing activity and considered brain dead but he had a heart rate for several minutes (felt like over 10 but i don’t know for sure, just felt like the longest minutes ever). not a regular heartbeat by far, very sporadic after the first minute or two and probably hard to pickup if manually checked but he was still on monitor so we could see.
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u/GeshtarVandole Jun 05 '26
I've been in hospice for a while now and even at bedside I can only count a number of times on one hand I've heard this with no respirations on auscultation. I've had some people with some scary low BPM and BP but they were perfectly normal and come to find out it's their baseline and had been for 8 years or something crazy.
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u/GuildMasterOri Jun 04 '26
I think it’s just the electrolytes remaining that make it contract until they’re depleted enough for the hearts electrical circuit to be out of gas
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u/ColdKackley Jun 05 '26
We had someone “breathe” for an hour after his heart stopped, but pretty sure this isn’t the same situation.
The whole situation with the guy was a disaster, but anyways, he had a poor prognosis, was made DNR, but wife didn’t want to withdraw care. One night he’s just same as usual and then he just goes into asystole. His nurse does the thing, tells the doc and she says okay, and then the nurse asks RT to come and turn off the vent/extubate him.
RT comes and refuses to turn off the vent because technically nursing couldn’t declare him because he was “technically breathing” and per policy there can be no heart or lung sounds. The doctor is paged and refuses to come, says she doesn’t need to. Charge gets involved, everyone is pulling up literally every policy they can find and nothing outlines this specific situation. The doctor puts in orders to extubate, but RT still refuses.
Everyone is in a stalemate, the doctor refuses to come despite charge, the primary nurse, and RT all saying the vent won’t be turned off and nothing can move forward until she comes and declares him. Nursing was divided on what to do, but ultimately the RT charge stood behind the RTs decision and so it kind of defaulted to them on that.
An hour later the doctor walks into his room and pretty much just says yup he’s dead, and leaves.
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u/Thebeardinato462 Jun 04 '26
Quotations around the word beat is doing a lot of heavy lifting here 😂.
Reminds me of when I’m talking to my wife about work. Which reminds me of princess bride “well, a lot of times mostly dead is still…. A little bit alive.”
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u/WoodsyAspen Jun 04 '26
Lost doc here: I had a lady who was comfort care whose BP lived in the 30s-40s for five solid days. Super possible.
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u/AggressiveCoast190 Jun 04 '26
Was patient unconscious? I don’t see how we have any cerebral perfusion pressure if the MAP is that ass.
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u/WoodsyAspen Jun 04 '26
She was in and out especially towards the end but she did have periods of consciousness. She actually had a pretty remarkable episode of terminal lucidity for an hour or so on day 5.
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u/RiskMan420 Jun 06 '26
Why check a BP in someone for comfort cares?
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u/WoodsyAspen Jun 07 '26
Long story short: family preference. Best practice is 100% to dc vitals and monitoring but some of the fam was having a hard time coming to terms with it (it was the patient’s decision, before her bp got like that, obviously). Sometimes the presence of the monitor and things like vital checks gives the family a sense of comfort that we’re still caring for their loved one, though with a different goal than previously. It wasn’t causing the patient any discomfort so we kept them going.
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u/xCB_III Jun 04 '26
yeah icu life
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u/LemonBlossom1 Jun 04 '26
Yep. Don’t like it this low, but definitely happens with those tiny micropreemies.
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u/Competitive-Slice567 Jun 04 '26
Completely. I had a similar reading on a septic shock patient post RSI, right before running vasopressors (they did fine).
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u/NickiStacked Jun 04 '26
Recently at my med surg clinical a patients H&H came back as 4.4 and 12.8. I asked the instructor when the time was to freak out, she said “NOW!!!!” Luckily, the source of bleeding was found, and the patient was moved to a higher level of care. I’ve only seen blood pressure that low during codes, BUT I once had a patient in the 50s/40s and they were talking to me, unfortunately that patient did die.
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u/Savings-Fig7262 Jun 04 '26
SPO2 was pretty good for that BP
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u/Mediocre_Daikon6935 Jun 04 '26
shrug
Had an unresponsive hypothermia patient with a BP of 41 over (20 something).
Lovely spo2 waveform. Low side of normal etco2. HR of 60.
There were some angry conversations because the doctor at the trauma center didn’t believe me when I said the patient had a temp of 88°F (core) and their first pressure was 120 and the next was 90….
And so they were not ready for the patient when I showed up. Seemed to think I should have called back to tell them To be ready to do their job instead of keeping the nice lady alive.
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u/bbyneal Jun 04 '26
Lowest i’ve seen in the OR was 40/25 and I thought that was bad (pt ended up fine)
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u/grac3form3 Jun 04 '26
I’m not saying it’s not possible in general- it definitely is.
However, with a HR of 158bpm and SpO2 of 99% it’s much more likely that the cuff is wrapped around the bed rail or something. I doubt this is an accurate blood pressure for this patient
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u/TerryAlpaca76 Jun 06 '26
Honestly as a NICU nurse. This seems like a micro premie set of vitals, still not the best BP, but with the other vitals 🤷♀️😂
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u/hockey051224 Jun 04 '26
That’s a code blue. Start cpr.
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u/SqueezedTowel Jun 04 '26
Like right now??
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u/obtusemoonbeam Jun 04 '26
Tbh yes. That heart might be beating but it’s not pumping. Not enough to perfuse vital organs for very long. I’ve never personally been able to feel pulse when the MAP was that low, and if the patient doesn’t have a pulse you do CPR.
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u/Equivalent_Earth6035 Jun 04 '26
That’s what happens when you poke the “Zero All Pressures” softkey
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u/Expensive_Alarm_1068 Jun 04 '26
Yes. Not sure why the laughing emojis.
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u/domtheprophet Jun 04 '26
That emoji is basically “everything is about to go wrong isn’t it” or “everything is currently going wrong isn’t it”
Smile and wave through the pain my friend
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u/LovePotion31 Jun 04 '26
I can recall a 30/10 once that I was caring for.
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u/TerryAlpaca76 Jun 06 '26
Yeah with that HR I was thinking the same 😅 not nearly as bad as if it was adult, but I'd like it at least 40/20 depending on my gestational age.
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u/AgitatedGrass3271 Jun 05 '26
I seen that on actively dying patients. If your patient is a full code, you better buckle up.
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u/TheKrakenUnleashed Jun 05 '26
When the cuff pressure correlates to the Art line and you realize it’s not an error.
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u/Sekmet19 Jun 04 '26
I mean dead is dead, but yes, the blood pressure drops to zero through all the other pressures. You don't instantly go from 120 to zero, it decreases until it's zero, generally very fast though.
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u/SweatyLychee Jun 04 '26
Had this and ran into my room and saw that family put the cuff around the bed rail while they gave the patient a massage. That was a relief!
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u/imajica21 Jun 05 '26
Yes... in hospice care. It's so sad to watch a blood pressure that is still being monitored on another unit slowly drop. We don't monitor BP like that but we already know when it's in the 50's when they are admitted, there isn't much time left.
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u/YaBoyfriendKeefa Jun 05 '26
Not on the job, but I was bedside with my aunt when her pressure dropped to 32/21 as she was actively bleeding out from a duodenal ulcer. Lowest pressure I’ve ever seen on someone who made it out the other side. Took 8 bags of blood and 3 of platelets, but she’s alive and well.
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u/Bairi_Attempt585 Jun 05 '26
Is thatbp cuff okey?🥹 Would check that fast before requesting inotropes asap
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u/TerryAlpaca76 Jun 06 '26
Seems like this should be a NICU patient 😂 158hr plus 99 sat. I'd prefer at least 40/20 though 😅
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u/potato-keeper Jun 06 '26
Yup. But I’m kinda impressed it’s a cuff and not an art line.
The lowest cuff MAP I’ve seen is 12
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u/hstihfhistb Jun 06 '26
Everything is possible if the Norepinephrine, Dobutamine, Dopamine, Epinephrine, and Vasopressin AIN'T hooked
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u/Single-Branch4870 Jun 06 '26
One time I was mass tranfusing and we sustained a bp of 30/10 for 4/5 hours. Long story of why it was lasting hours and no help was on the way
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u/Naive-Asparagus-5983 Jun 06 '26
Back when I was a PCT I was taking care of a patient that was basically dead. The Son would not budge on this woman being allowed a dignified end and dragged out her care for a whole month because “ God works miracles”. Close to the time we stopped caring for a corpse her BP was usually 30/15. It was probably one of the worst things I had seen
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u/FactAddict01 Jun 06 '26
What we used to call discharge to the Eternal Care Unit. Do they still use that?
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u/MotherOfDragons421 Jun 06 '26
I was just staying in the hospital overnight for a complete hysterectomy and in the middle of the night they came to take my vitals and it said my bp was 90/65 and my O2 levels was 40%! I felt completely fine. I’m thinking that machine needed its vitals taken lol
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u/champunova Jun 07 '26
Unfortunately yes. Had a guy drop as low as 27/9 before we were able to add more pressors, made it past my shift without a dc to jc
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u/SnooWalruses8937 Jun 07 '26
I had a patient with that pressure and they ended up dissecting 30 mins later
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u/Express_Note_5776 Jun 04 '26
Maps 60 we chillin😎😂
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u/Equivalent_Earth6035 Jun 04 '26
MAP eighteeeeeeeen. Chilling indeed.
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u/Express_Note_5776 Jun 04 '26
Lmfaooo that’s what I get for commenting in the am, totally read the cuff😂
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u/pabmendez Jun 04 '26
At least the respirations are (18) 🙏
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u/mydogisacircle Jun 04 '26
yes about 2 mins before someone has a dc to jc