hypertensive emergency - ccs - usmle_123456

[ArchivalUser]

can anyone give the step wise approach? thanx

[ArchivalUser]

Based on Uworld's approach:

First it's an emergency case..you need to place emergency orders:
IVA
pulse ox
oxygen
BP monitor
Cardiac Monitor

Then proceed to focused physical exam:
No need to do breast, genital and rectal exams now in this distressed patient.

Then you need to run tests to check for end organ damage due to the high blood pressure...and of course the most important thing here is to exclude brain hemorrage.

Head CT non contrast (to rule out hge)
CBC
BMP (there could be signs of renal failure)
UA (Again could be signs of renal failure)
12 lead EKG (High BP will affect the heart...signs of LVH)
CXR (to rule out aortic dissection or something)

Advance clock to get CT results..No hemorrage...only then can you start treating for the HTN

Give Nitrprusside IV
Admit to ICU and monitor BP

Place the patient on NPO , complete bed rest and measure urine output

Keep following up every 30 minutes, checking on BP till patient improves

Don't forget in your five minute screen to counsel for smoking cessation, alcohol abstinence, exercise, low salt diet, medication compliance.
And get LFTs and a lipid profile while you are at it.

[ArchivalUser]

must put an arterial line before beginning nitroprusside

[ArchivalUser]

I cant find an arterial line on the order sheet.
I don't know how you are supposed to order that

[ArchivalUser]

It is better to type only few letters to broaden search. If you typed arterial "arterial catheter insertion" option comes up. , choose that one. That is arterial line

[ArchivalUser]

thanks a lot

[ArchivalUser]

thanx.. if hamerrhage on ct, what do we do? i thought ischemia is a prob. could anyone explain this? thanx

[ArchivalUser]

if there is hemorrhage on CT then we cant give nitroprusside. It's a hemorrhagic stroke...
If the patient is on anticoagulants we will have to stop them...maybe give FFP and vitamin K to reverse their effect.
we move to the ICU..

and i think you just manage conservatively...
I don't think there is much we can do about hgic stroke.

Get a neurosurgery consult..and in some cases they can evacuate the bleeding if it has formed a hematoma.

Any one has any other suggestions?

[ArchivalUser]

if hemorrhagic stroke with high bp, why cant we give antihypertensives?
if ischemic stroke, we give antihypersentives if bp > 220/120.