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Hypertensive Emergencies - Dr. Godfrey

6/19/2014

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Picture
Core Concepts from Hypertensive Emergencies
Trick or Treat?

 
Definitions:
Asx HTN <220/120 without complaints
HTN urgency >220/120 w/o end organ damage
HTN emergency >220/120 + end organ damage
 
When to treat asx HTN?
If BP >165/105 + Cr >2, start two agents
or >220/>120 without any dysfunction, two agents
If  140-165: Controversial, but at the very least, tell the pt and Fast-track them
*Social intervention*
 
Rx:
No comorbidities:
black, all ages: CCB or TZD
white, <60 ACEI or ARB
white, >60, CCB or TZD
 
HTN
+ DM: ACEI or ARB
+ CKD: ACEI or ARB
+ CAD: BB + ACEI or ARB
+ CVA: ACEI or ARB
+ CHF: ACEI or ARB + BB + diuretic
 
HTN Urgency:
don't need to treat in the ED.
Do at least an EKG and check Cr. Plus fundoscopy and lytes
 
HTN Emergencies-
Aortic Dissection
Make the Dx and STOP progression
Listen for AI murmur and assess for acute heart failure
If no murmur and no failure, proceed with IV BB
Safe: morphine + nicardipine
 
Hypertensive Encephalopathy
Decrease MAP 25% in 8 hours
use comorbid appropriate therapy
Give something IV and admit
 
ICH
Let it ride unless >220/110
generally avoid nitroprusside with neurologic emergencies
Pick anything else. We like labetalol
 
Acute Ischemic Stroke
If tPA candidate, treat if BP >185/110
Otherwise, protect the penumbra
 
SAH
No good guidelines
MAP<130
Lookout for complications in the first 24 hours
 
ACS
Treat if >160/>110
No lytics if >185/>110
Use NTG (paste, SL, IV), then BB if needed
 
ACHFE
the higher the initial BP, the better chance of survival
nitro + enalaprilat +/- lasix if they have evidence of fluid overload
 
Cocaine
ASA + lorazepam
backup: NTG, CCB or phentolamine
BB dogma is lifting
 
Eclampsia
IV mag + labetalol or hydralazine

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  • Prospective Applicants
    • 2020 MATCH
    • About CMC
    • Our Curriculum
    • Our Residents
    • Our Fellowships
    • Program Leadership
    • Explore Charlotte
    • Official Site
  • ROTATING STUDENTS
    • Prospective Visiting Students
    • UNC Students
    • Healthcare Disparities Externship
    • Current Students
  • Current Residents
    • Airway Lecture!
    • PGY - 1
    • PGY - 2
    • PGY - 3
    • Simulation Reading
    • Blogs >
      • EM GuideWire
      • CMC ECG Masters
      • Core Concepts
      • #FOAMed
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
    • Board Review
    • Journal Club
    • Resident Wellness
    • Resident Research
  • Top 20
  • Chiefs Corner
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Individualized Interactive Instruction
    • Evaluations/Interview Season
    • Contact Info
    • Resume Builder