History:

 

• Documented hypertension
• Pregnancy
• Medications (compliance ?)
• Related diseases
  • Diabetes
  • CVA
  • Renal failure
  • Cardiac
• Erectile dysfunction medication
  • Levitra
  • Cialis
  • Viagra

 

Significant Findings:

 

• One of these

• • Systolic BP >220
  • Diastolic BP >120

 

• AND at least one of these

• • Headache
  • Nosebleed
  • Blurred vision
  • Dizziness

 

Differential:

 

• Hypertensive encephalopathy
• Primary CNS injury
  • Cushing's response (bradycardia with hypertension)
• Myocardial infarction
• Aortic dissection/aneurysm
• Eclampsia/pre-eclampsia

 

Treatment:

 

• Oxygen

• Initiate IV

• 12 Lead EKG

 

Respiratory Distress ?

 

• Yes

 

• • See Pulmonary Edema Protocol

 

• No

 

Pregnancy ?

 

• Yes

 

• • See Eclampsia/Preeclampsia

 

• No

 

Headache or mental status change ?

 

• Yes

 

• • Consider Stroke Protocol

 

• No

 

• • Nitroglycerin Paste 1 gram / 1 inch

 

• • Notify receiving facility or contact Medical Control

 

PEARLS:

 

• Never treat elevated blood pressure based on one set of vital signs or on vital signs alone.
• Check blood pressure in both arms.
• Symptomatic hypertension is typically revealed through end organ damage to the cardiac, central nervous system or renal systems.
• All symptomatic patients with hypertension should be transported with their head elevated.
• Consider aortic aneurysm if patient is experiencing severe or dull pain in the abdomen, chest, lower back or groin. Risk factors for aortic aneurysm include male patients (4 of 5 patients are males), greater than 60 years old, smoking, and diabetes.