Permissive Hypotension
Permissive hypotension is an accepted principle in the management of a trauma patient in hemorrhagic shock and can be useful until the source of bleeding can be promptly controlled. However, use of permissive hypotension carries with it the risk of damage to vital organs such as the heart and brain, however. Coronary artery perfusion is dependent on diastolic blood pressure and filling of the heart during diastole. Both are decreased during permissive hypotension. Patients with preexisting coronary artery disease are at risk from decreases in coronary artery perfusion and might go on to develop life-threatening arrhythmias or possibly damage of the cardiac muscle, as presumably occurred in this case. If one is to utilize the technique of permissive hypotension for several hours until the source of the hemorrhage is dealt with, one must carefully monitor signs of low perfusion such as urine output, arterial pH, oxygen saturation, lactic acid levels, and the extent of the anion gap.
Permissive hypotension medical expert witness specialties include anesthesiology, cardiac anesthesiology, obstetric anesthesiology, trauma, and emergency medicine.