becoming a better Clinician
Hypertension
Hypertensive Emergency
Hypertensive Crisis
Hypertensive Crisis
Hypertensive Emergency
Hypertensive Crisis (2 types):
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hypertensive urgency
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hypertensive emergency
Hypertensive urgency
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> 180/110 mmHg
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no associated end-organ damage
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may have the following symptoms
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headaches
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shortenss of breath
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nosebleeds
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anxiety
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Hypertensive emergency
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> 180/110 mmHg (but can occur at lower pressures if the blood pressure rises acutely)
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associated with end organ damage
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stroke
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loss of consciousness
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heart attack
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aortic dissection
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chest pain
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pulmonary edema
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damage to eyes
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damage to kidney
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Nipride (Nitroprusside)
50mg/250mL
MOA: breaks down into NO
maintenance: 0.5-10mcg/kg/min (max 10)
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thiocyanate levels > 48 hours use
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decreases preload/afterload
Cyanide toxicity:
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produces cellular hypoxia
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electron transport chain inhibited preventing ATP formation
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coronary steal syndrome
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↑ICP (NP impair autoregulation)
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restlessness, agitation, sinus tachycardia
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↑lactic acid
Esmolol (Brevibloc)
2.5g/250mL or 2g/100mL
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bolus: 500mcg/kg over 1 minute
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25-50mcg/kg/min (max: 300); titrate ↑↓every 20minutes
SE: heart block