All Emergencies - Basic life support principles:

  1. Maintain an airway
  2. Assess breathing
  3. Monitor circulation
Monitor and record all vital signs.
Hypertension Under Sedation
Hypertension is only an emergency if it is symptomatic - headache, pain, CVA risk or signs


Most Common Causes:

  1. Poorly controlled pre-existing hypertension
  2. Inadequate analgesia or sedation
  3. Abnormal blood gases
  4. Medications - overuse of sympathomimetics, especially epinephrine





  1. If symptomatic and diastolic BP > 100, administer nitroglycerine - 1 tab q5 min, up to 3 times.
  2. If still symptomatic, activate EMS
  3. Malamed states acute hypertension is extremely uncommon. Nitroglycerin or nifedipine (Procardia) can be used to lower BP



  1. Deepen the sedation and analgesia in parallel with changing stimuli
  2. Prevent hypercapnia (elevated CO2) & hypoxemia
  3. Rule out less common causes


If IV can be started

  • Establish IV infusion
  • Titrate nitroprusside (Nipride) @ 5 mg/kg/min infusion rate until BP lowered to desired point
  • If myocardial infarction or congestive heart failure is present:
    • IV nitroglycerin or nitroprusside (50 microgram bolus, followed by 10-20 microgram/minute
    • IV Diazoxide (Hyperstat) - administer 1-3 mg/ky, up to 150 mg. May repeat q5-10 min. up to 600 mg.
    • When anxiety is a major component of the hypertension - midazolam or diazepam can be titrated

Source: Sedation, A Guide to Patient Management by Stanley F. Malamed