
|

|
All Emergencies - Basic life support principles:
- Maintain an airway
- Assess breathing
- 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:
- Poorly controled pre-existing hypertension
- Inadequate analgesia or sedation
- Abnormal blood gases
- Medications - overuse of sympathomimetics, especially epinephrine
Management:
Symptomatic:
- If symptomatic and diastolic BP > 100, administer nitroglycerine - 1 tab q5 min, up to 3 times.
- If still symptomatic, activate EMS
- Malamed states acute hypertension is extremely uncommon. Nitroglycerin or nifedipine (Procardia) can be used to lower BP
Asymptomatic:
- Deepen the sedation and analgesia in parallel with changing stimuli
- Prevent hypercapnia (elevated CO2) & hypoxemia
- 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
|
|
|