Introduction
One high-risk population group is patients with low flow states. The many implications of this are reviewed.
Disclaimers
This is for general health education purposes only.
Discussion
Patients with low flow states must be identified early, because they must be treated differently as soon as they are identified. This implies to emergency situations. This applies to general health care maintenance. They will respond differently to disease from other patients. And if a clinician is not in tune with the possibility that they are a low flow state patient, the doctor will slight their care, and the outcome will be poor.
Clues to low flow states can be remembered in the pneumonic “lOw flOw STAteS”
shOck (incl. pts drop bp during dialysis)
On mult pressOrs
end STAge cardiomyopathies
Sepsis
(=> poor gut perfusion <- critically ill)
The low blood pressure that occurs in any form of shock means their end organ tissues are not getting perfused. This is probably the most dangerous low flow state. It’s almost always fairly obvious.
Patients on multiple pressers, dopamine, dobutamine, usually I see you patients, our patients in a low flow state. Depressors are being used to increase the perfusion of their tissues. By definition, they have big problems. I guarantee you the ICU clinician or pulmonologist is well aware of this low flow state, and treats them with every move he makes in a very special way.
End stage cardiomyopathies. Cardiomyopathies in general are treated very differently from all other patients. But end stage cardiomyopathies… These patients are now permanently in a low flow state. That must be borne in mind at all times when managing their healthcare.
Sepsis, almost always at risk for becoming a shock state, is a low flow state even before that happens. Perfusion of tissues is always threatened in sepsis. Before sepsis turns into shock, perfusion of the gut is already terrible. Of course once sepsis turns into shock, perfusion of all tissues becomes poor.
Conclusion
Low flow states must be identified immediately
So the clues in a pneumonic are nice so you can always keep them in mind, and never ever miss them.
- lOw flOw STAteS”
- shOck (incl. pts drop bp during dialysis)
- On mult pressOrs
- end STAge cardiomyopathies
- Sepsis
They must be managed differently from everybody else.
