1 of 35

Slide Notes

DownloadGo Live

Hypertensive Emergencies

Published on Nov 18, 2015

No Description

View Outline

MORE DECKS TO EXPLORE

PRESENTATION OUTLINE

1.

HYPERTENSIVE EMERGENCIES

PRAKASH VEMULAPALLI
Photo by Shardayyy
2.

Untitled Slide

Photo by France1978
3.

When in Doubt...

Start at the beginning
Photo by faceless ekone
4.

IS MY CLINIC PATIENT HYPERTENSIVE?

THE ANSWER HAS CHANGED...
Photo by jasleen_kaur
5.

JNC 7
definition of hypertension

6.

NEW JNc 8 GUIDELINES

2014 UPDATE (LAST UPDATE 2003 JNC 7)
Photo by NS Newsflash
7.

18-60 YEAR OLDS OR ANY PATIENT WITH CKD/DM

BLOOD PRESSURE GOAL OF less than 140/90
Photo by zilverbat.
8.

PATIENTS OLDER THAN 60 WITH NO CKD/DM

BLOOD PRESSURE LESS THAN 150/90
Photo by gagilas
9.

EFFECTIVE LONG-TERM BP CONTROL

reduces cerebrovascular events, heart failure, and overall mortality
Photo by Dr. RawheaD
10.

"BUT MY BLOOD PRESSURE AT HOME WAS 200/100!"

WHAT TO DO NEXT?
Photo by photoloni
11.

HYPERTENSIVE EMERGENCY VS ASYMPTOMATIC HYPERTENSION

ASSESSMENT STRATEGY
Photo by tim caynes
12.

R.N.C.

THE HYPERTENSIVE KILL LIST
Photo by cliff1066™
13.

RENAL

ACUTE RENAL INJURY/FAILURE
Photo by Kaptain Kobold
14.

NEUROLOGIC

  • Hypertensive encephalopathy
  • Intracranial hemmorhage
  • Cerebral infarction
Photo by EUSKALANATO
15.

CARDIOVASCULAR

  • Acute MI
  • Acute pulmonary edema
  • Left ventricular dysfunction
  • Aortic dissection
Photo by biologycorner
16.

MOST COMMON PRESENTATIONS

  • Cerebral infarction 24.5%
  • Pulmonary edema- 22.5%
  • Hypertensive encephalopathy -16.3%
  • CHF 12%
Photo by gerlos
17.

DIAGNOSTICS

EKG, CBC, BMP, PT/PTT, TROPONIN, UA (?), CHEST X-RAY (?), CT HEAD(?)
Photo by US Army Africa
18.

HYPERTENSIVE ENCEPHALOPATHY

DIAGNOSIS AND TREATMENT
Photo by PinkPersimon
19.

EPIDEMIOLOGY

  • 60 million Americans with hypertension
  • 1% will have an emergency in their life
  • 6 month mortality 50% when untreated
  • More frequent in men and in blacks
Photo by marfis75
20.

PRESENTATION

HEADACHES, CONFUSION, SEIZURE, NAUSEA, VOMITING
Photo by 19melissa68
21.

ONSET OF SYMPTOMS OVER 24-48 HOURS

NEXT 24-48 HOURS WITH NEUROLOGIC PROGRESSION
Photo by mark sebastian
22.

PATHOLOGY

LOSS OF BLOOD-BRAIN BARRIER, CAPILLARY LEAK, AND BRAIN EDEMA (prES)
23.

PAPILLADEMA

HEMMORHAGE AND EDEMA
24.

MaP REDUCTION BY 25%

1) LABETALOL, 2) NICARDIPINE WITH CAVEATS
Photo by quinn.anya
25.

ASYMPTOMATIC ELEVATED HYPERTENSION

(OR WHAT MOST ED PATIENTS HAVE)
Photo by Alex E. Proimos
26.

TO SCREEN OR NOT TO SCREEN

RECOMMENDATIONS FOR SCREENING LABS
Photo by thisisbossi
27.

JNC 7

ECG, CXR, CBC, BMP (CR), AND UA (PROTEINURIA)
Photo by lydia_shiningbrightly
28.

PER ACEP 2006 GUIDELINES

ROUTINE SCREENING (BMP, UA, ECG) IS NOT REQUIRED
Photo by Peter Kaminski
29.

SCREENING BMP

SCREENING BMP MAY IDENTIFY AKI IN SELECT POPULATIONS ( EG POOR FOLLOW-UP)
Photo by MDGovpics
30.

TO TREAT OR NOT TO TREAT

(AND WHAT TO TREAT WITH)
Photo by Scott*
31.

ACEP 2006 GUIDELINES

NO ROUTINE ED INTERVENTION IS REQUIRED (CAN CAUSE HARM)
Photo by kevin dooley
32.

TREATMENT OPTIONAL

SUBSET OF PATIENTS (POOR FOLLOW-UP) OR 200/120 CAN INITIATE TREATMENT ON DISCHARGE
Photo by Son of Groucho
33.

USUAL FIRST LINE THERAPIES

ACE-I, THIAZIDES
Photo by monkeyc.net
34.

REFER

ALL PATIENTS WITH ELEVATED ASYMPTOMATIC HYPERTENSION
Photo by DFAT photo library
35.

THANKS

TO MY WIFE, THE HUSTLAS, DR.SILBERMAN, AND DR. CARTER FOR LETTING ME IN
Photo by frumbert

Prakash V