HYPERTENSIVE EMERGENCIES Flashcards

1
Q

MANAGEMENT

A

DEFINITION

IF Acute elevated blood pressure (>180/120) associated with end organ dysfunction (brain, heart, kidneys, eyes, aorta) initiate treatment

MANAGEMENT
Target 25% reduction of the MAP over the first hour

Vasodilators: Nitroglycerins, Sodium Nitroprusside, Hydralazine

B-Blockers: labetolol, esmolol

A-Blockers: Phentolamine, Nicardipine, Enalapril

INVESTIGATIONS
Creatinine
U/A - proteinuria
BHCG - r/o pre-eclampsia
TSH
ECG - LVH, ischemic changes
CXR - pulm edema, widening mediastinum

DOCUMENTATION

Cardiac: CP, SOB, Edema

Renal: Polyuria, Hematuria, Edema

CNS: Visual Change, Headache, Nausea, Confusion, Focal Symptoms, Vague dizziness

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2
Q

DDX: END ORGAN DYSFUNCTION

A

Stroke
Encephalopathy
CHF
Aortic Dissection
MI / Unstable Angina
Intracerebral Hemorrhage

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3
Q

AORTIC DISSECTION

A

DUAL THERAPY

Esmolol
500 mcg/kg over 1-3 min followed by infusion of 50-200 mcg / kg / min

AND

Nitroprusside 0.5-3 mcg / kg / min

MONOTHERAPY

Labetolol
10 mg IV over 2 min q 5-10 min until HR is achieved or 300 max

HR Target < 60
THEN
SBP Target < 120 within 20 min

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4
Q

ACUTE PULMONARY EDEMA

A

Nitroglycerin:
0.4 mg 1-2 sprays SL q5min x 3 (if SBP > 90)
OR
patch (0.4-0.8 mg/h)
OR
IV: 5-10 mcg / min, titrate to max 200 mcg/min

Goal: Reduce BP by 20-30%

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5
Q

STROKE

A

Preferred Agents:

Labetolol
10 mg IV over 2 min q 5-10 min until HR is achieved or 300 max

Nicardipine
5 mg / hr IV. INcrease by 2.5 mg / h q 15 min to max 15 mg / h

Goals:
If Fibrinolytic Therapy target BP <185/110 mmHg
If NO Fibrinolytic Therapy
BP by 15% in the first 24 hrs IF SBP >220 or DBP > 120

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6
Q

UNSTABLE ANGINA

A

Nitroglycerine:
0.4 mg 1-2 sprays SL q5min x 3 (if SBP > 90)
OR
patch (0.4-0.8 mg/h)
OR
IV: 10 mcg / min, titrate to
Goals: 10% reduction in MAP if normotensive, 20-30% reduction in MAP if hypertensive.

labetolol: 20 mg IV (5-10 mg) with additional doses 20, 40, 80 to total 300 q 10 min
OR
1-2 mg / min
C/I moderate - servere LV Failure with pulm edema, bradycardia (<60), hypotension (<100), poor peripheral perfusion, 2-3 degree HB, reactive airway disease

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7
Q

INTRACRANIAL HEMORRHAGE

A

CONSULT NEUROSURGERY FIRST

SBP > 220 mm Hg may consider lowering BP by 20% after consultation
Avoid Rapid Drop

labetolol: 20 mg IV (5-10 mg) with additional doses 20, 40, 80 to total 300 q 10 min
OR
1-2 mg / min

Nicardipine:
5 mg / hr IV. INcrease by 2.5 mg / h q 15 min to max 15 mg / h

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8
Q

SUBARACHNOID HEMORRHAGE

A

Treatment Goals: SBP < 140????

labetolol: 20 mg IV (5-10 mg) with additional doses 20, 40, 80 to total 300 q 10 min
OR
1-2 mg / min

Nicardipine:
5 mg / hr IV. INcrease by 2.5 mg / h q 15 min to max 15 mg / h

Nimodipine PO 60 mg q 4 hr reduces vasospasm

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9
Q

HTN ENCEPHALOPATHY

A

labetolol: 20 mg IV (5-10 mg) with additional doses 20, 40, 80 to total 300 q 10 min
OR
1-2 mg / min

Nicardipine:
5 mg / hr IV. INcrease by 2.5 mg / h q 15 min to max 15 mg / h

Hydralazine: 5 mg IV, repeat 5-10 mg q 20 min

Treatment Goal: Reduce MAP by 20-25% or to dBP 100-110 over 1 hour

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10
Q

PRE-ECLAMPSIA

A

ANY DBP > 100 = EMERGENCY

Start Magnesium Sulfate IV

Labetolol: 20 mg IV (5-10 mg) with additional doses 20, 40, 80 to total 300 q 10 min
OR
1-2 mg / min

Hydralazine: 5 mg IV, repeat 5-10 mg q 20 min

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