In a hypotensive patient, which finding would lead a paramedic to withhold IV fluid boluses?

In a hypotensive patient, which finding would lead a paramedic to withhold IV fluid boluses?

• A. Recent NTG use
• B. Daily use of ACE inhibitors
• C. Diffuse crackles upon auscultation
• D. History of renal calculi

Answer: (C)

Diffusive crackles across the lungs signal pulmonary edema from left‑sided heart failure. In a hypotensive patient, that edema means the heart isn’t handling incoming volume well, so giving IV fluid boluses would raise preload and pulmonary capillary pressure, worsening edema and oxygenation. The safer approach is to withhold fluids and focus on supporting oxygenation and perfusion while addressing the cardiogenic process (and using vasopressors if indicated). The other findings don’t directly indicate volume overload: recent nitro use can cause vasodilation and lower BP, ACE inhibitors can lower BP chronically, and a history of renal stones doesn’t relate to volume status.

Diffusive crackles across the lungs signal pulmonary edema from left‑sided heart failure. In a hypotensive patient, that edema means the heart isn’t handling incoming volume well, so giving IV fluid boluses would raise preload and pulmonary capillary pressure, worsening edema and oxygenation. The safer approach is to withhold fluids and focus on supporting oxygenation and perfusion while addressing the cardiogenic process (and using vasopressors if indicated). The other findings don’t directly indicate volume overload: recent nitro use can cause vasodilation and lower BP, ACE inhibitors can lower BP chronically, and a history of renal stones doesn’t relate to volume status.