Acute Hypertensive Crisis Flashcards
What defines hypertensive crisis
> 180 SBP and/or >120 DBP
name 4 cause of HTN Crisis
Clonidine withdraw
Serotonin Syndrome
non-medication adherence
recreational drugs
Do all patients have symptoms?
No patients can be asymptomatic
what are the 4 symptoms of HTN crisis
Confusion/Headache
Blurred Vision
Chest pain
NV
What are 4 complications from acute HTN crisis
Stroke
heart attack, HF, Aortic Dissection
Retinopathy
Renal failure
flow chart of HTN crisis
htn emergency vs urgency
Organ Damage becomes an emergency
What to do with HTN Urgency
Start or up oral therapy
then follow up 2-4 weeks later
What to do with HTN Emergency (No Eclampsia or Aortic Dissection)
Reduce BP below 180/120 but not excceding 25%
then 160/110-100 over the next 2-6 hrs
then normal 24-48hrs
BP goal for preclampsia
Reduce BP to <140 SBP in the first hour
What are the 3 treatment goals for Aortic dissection?
<120 SBP in the first hour
HR to 80-60 bpm
Pain Control
3 Sign and Symptoms of Aortic Dissection
Knife-like pain in either the stomach or chest
Elevated kidney and liver
loss of pulse in extremities
How to treat Aortic Dissection
Esmolol 500mcg/kg bolus then 50mcg/kg/min infusion
Labetalol 20mg bolus then 10mg/HR infusion
why do we use esmolol more often
Esmolol is more on hand while labetalol would need to be compounded
When would I use IV vasodilators in the treatment of Aortic Dissection?
additional BP control
How would I titrate Esmolol
25-50mcg/kg/min every min till at goal
MAX 300mcg/kg/min