Protocol Status: PUBLISHED
Protocol:
Version: 2026.01
Effective Date:
Last Reviewed:
Medical Director Approval:
Clinical Note: This content reflects current GCEMS clinical guidelines as of the dates listed above. If content appears inconsistent with current policy, use the most recent approved guideline and notify leadership for correction.

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.