Severe Atelectasis followed by Hypoxic Pulmonary Vasoconstriction (HPV)

Mechanism of Action : Severe Atelectasis followed by Hypoxic Pulmonary Vasoconstricion (HPV).

2 min Evaluation – Urimeter – translucent green – 10 seconds to reach a conclusion

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The quick explanation :

Situation :    urine = (translucent) green.

Background :    hypotension.

Action :    methylene blue intravenous injection.

Recommendation :     Alveolar recruitment technique (ART).

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The “long winded” explanation :

S-B-A-R format reporting – quick reporting format for handoff from one healthcare professional to another.

A lot of this presentation is conjecture … but time and experience has proven correct 99 out of 100 times.

Translucent green urine – refractory systemic vascular hypotension (from excessive nitric oxide in general systemic circulation) >  methylene blue dye irreversibly binds nitric oxide (NO) molecules – systemic blood pressure should increase status post  random scavenging.

The patient’s vascular system is producing excessive amounts of nitric oxide in endovascular epithelial tissue.
Last resort to refractory hypotension is to offer a free floating agent in the cardiovascular system to be reduced by nitric oxide
and thereby decrease the systemic vascular dilation (increased SVR) by “free range” nitric oxide.

Last resort because methylene blue is nephrotoxic.