CARDIOLOGY
HYPERTENSION
PromptDefinition of hypertensive urgency
ResponseSBP >180 or DBP>120 WITHOUT end organ dysfunction
PromptDefine hypertensive emergency
ResponseSBP >180, DBP>120 WITH end organ dysfunction
Includes Malignant Hypertension and Hypertensive Encephalopathy, Dissection, Pre-eclampsia, MI, Pulmonary Oedema, Cocaine/Amphetamine, Renal Failure, Stoke (CVA, SAH, ICH) and Pheochromocytoma.
Includes Malignant Hypertension and Hypertensive Encephalopathy, Dissection, Pre-eclampsia, MI, Pulmonary Oedema, Cocaine/Amphetamine, Renal Failure, Stoke (CVA, SAH, ICH) and Pheochromocytoma.
PromptEnd organ examples + clinical investigations
Response
PromptManagement Priorities
ResponseAnalgesia (0.5marks): Fentanyl or Morphine (0.5 marks)
Anti emetic (0.5marks): Ondansetron or equivalent (0.5 marks)
Supplemental Oxygen to correct high RR and low O2 saturations (1 mark)
Immediate controlled reduction of blood pressure (1 mark) with the target of loweringinitial MAP by 25% or diastolic to 110mmHg over the first hour (1 mark).
Followed by a gradual decrease in blood pressure to 160/100 over the next 4-6hours (1mark).
Mention of medications used to facilitate the reduction in blood pressure: a B blocker (Labetolol or Esmolol) (1 mark) and either GTN or sodium nitroprusside (1 mark).
Anti emetic (0.5marks): Ondansetron or equivalent (0.5 marks)
Supplemental Oxygen to correct high RR and low O2 saturations (1 mark)
Immediate controlled reduction of blood pressure (1 mark) with the target of loweringinitial MAP by 25% or diastolic to 110mmHg over the first hour (1 mark).
Followed by a gradual decrease in blood pressure to 160/100 over the next 4-6hours (1mark).
Mention of medications used to facilitate the reduction in blood pressure: a B blocker (Labetolol or Esmolol) (1 mark) and either GTN or sodium nitroprusside (1 mark).
PromptGoal of treatment
ResponseReduce MAP by 15-20% in 1-2 hours
PromptMedications and doses for management
ResponseBeta blockers
- Metoprolol 5mg IV every 5 mins
- esmolol 0.5-1mg/kg bolus then infusion 50-300mcg/kg/min
- Hydralazine 5-20mg IV every 30minutes
- SNiP 0.25-10mcg/kg/min infusion
- GTN 50mg in 500ml commence 5mls/hr & titrate – 50-200mcg/kg/min
PromptDifferentials for hypertensive encephalopathy
ResponseICH
Meningioencephalitis/other intracranial infection (Abscess, toxoplasmosis)
SOL - primary or secondary
Carotid artery dissection
Haemorrhagic CVA
Migraine
hypoglycaemia
Tox - CO poisoning
Meningioencephalitis/other intracranial infection (Abscess, toxoplasmosis)
SOL - primary or secondary
Carotid artery dissection
Haemorrhagic CVA
Migraine
hypoglycaemia
Tox - CO poisoning
PromptHypertensive encephalopathy management
Response ??as above basically.