Hypertensive Crisis

 

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

 

 

  • No

 

Pregnancy ?

 

  • Yes

 

 

  • No

 

Headache or mental status change ?

 

  • Yes

 

 

  • No

 

 

    • 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.