Guest guest Posted May 4, 2008 Report Share Posted May 4, 2008 Is there a recognized condition/diagnosis of " hypertensive crisis? " For years many services had protocols for such a condition, and some still do. However, for the last several years I have been reading literature that contends there's no such condition that requires treatment to lower BP with anything other than oral antihypertensives, and no reason to start treatment in the field. We all, I hope, understand the considerations for patients with possible CVA, and that it is inappropriate to lower BP in the field since there needs to be a CT done to determine whether or not the CVA is obstructive or hemorrhagic. No problem there. But what about patients with elevated BP and no " obvious " signs of CVA. [OK, can we rule out CVA in the field? What about patients with atypical CVA presentation?] What about patients who present with headache/nausea/vomiting and have " elevated BP " ? What does " elevated " mean? I just read a physician's comment on another list that such patients usually have migraines. Therefore, treatment should be for the migraine and not for the BP. So, I ask the question. Is there a recognized condition/diagnosis of " hypertensive crisis " and if so should it be treated in the field? What are the rules for recognizing it if it exists? What are the preferred treatments? We don't and can't carry Nipride very well; labetalol is fine if infused; NTG OK if infused but probably not OK by SL/spray. How many services carry IV pumps and labetalol/Tridil? I have recently seen some protocols that address " hypertensive crisis " and provide BP perimeters for treatment. I'm skeptical of that approach. Isn't that treating " numbers " rather than the patient? Your thoughts? Gene G. Truth-Seeker IV (ret.) ************** Wondering what's for Dinner Tonight? Get new twists on family favorites at AOL Food. (http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2008 Report Share Posted May 5, 2008 Your experience mirrors mine. I realize we're talking semantics to a degree. Hypertensive emergency/hypertensive crisis/hypertensive urgency. Who made up those names and wrote the definitions of them? How many physicians, if presented with a questionairre about hypertension, hypertensive crises, hypertensive urgencies, and hypertensive emergencies would answer a well constructed poll in any way that would lend to any sort of enhanced understanding about this problem, if it is in fact a problem? GG > > Everything I read would indicate pre-hospital treatment is contraindicated. > If, however, pre-hospital treatment is going to be provided by an EMS > provider, it should be to treat the s/s (CP, back pain, SOB, or neuro > signs), not simply to treat the numbers. We all learn in school that we > should treat the patient, not the machines. > > I couldn't find a clear definition of hypertensive crisis. I found several > inclusion criteria to diagnose hypertensive urgency and hypertensive > emergency, but nothing to truly define a " crisis " . > > Just a few early morning thoughts.... > > Neil > > > > > Is there a recognized condition/diagnosis of " hypertensive crisis? " > > > > For years many services had protocols for such a condition, and some still > > > > do. However, for the last several years I have been reading literature > > that > > contends there's no such condition that requires treatment to lower BP > > with > > anything other than oral antihypertensives, and no reason to start > > treatment in > > the field. > > > > We all, I hope, understand the considerations for patients with possible > > CVA, > > and that it is inappropriate to lower BP in the field since there needs to > > be > > a CT done to determine whether or not the CVA is obstructive or > > hemorrhagic. > > No problem there. > > > > But what about patients with elevated BP and no " obvious " signs of CVA. > > [OK, > > can we rule out CVA in the field? What about patients with atypical CVA > > presentation? presentation?<wbr>] What about patien > > headache/nausea/ headache/na > > have " elevated BP " ? What does " elevated " mean? > > > > I just read a physician's comment on another list that such patients > > usually > > have migraines. Therefore, treatment should be for the migraine and not > > for > > the BP. > > > > So, I ask the question. Is there a recognized condition/diagnosis of > > " hypertensive crisis " and if so should it be treated in the field? What > > are the > > rules for recognizing it if it exists? What are the preferred treatments? > > We > > don't and can't carry Nipride very well; labetalol is fine if infused; NTG > > OK > > if infused but probably not OK by SL/spray. How many services carry IV > > pumps and labetalol/Tridil? > > > > I have recently seen some protocols that address " hypertensive crisis " and > > > > provide BP perimeters for treatment. I'm skeptical of that approach. Isn't > > > > that treating " numbers " rather than the patient? > > > > Your thoughts? > > > > Gene G. > > Truth-Seeker IV (ret.) > > > > ************ * > > Wondering what's for Dinner Tonight? Get new twists on family > > favorites at AOL Food. > > > > (http://food.http://food.<wbhttp://food.http://food.<wbrhttp) > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2008 Report Share Posted May 5, 2008 Everything I read would indicate pre-hospital treatment is contraindicated. If, however, pre-hospital treatment is going to be provided by an EMS provider, it should be to treat the s/s (CP, back pain, SOB, or neuro signs), not simply to treat the numbers. We all learn in school that we should treat the patient, not the machines. I couldn't find a clear definition of hypertensive crisis. I found several inclusion criteria to diagnose hypertensive urgency and hypertensive emergency, but nothing to truly define a " crisis " . Just a few early morning thoughts.... Neil > Is there a recognized condition/diagnosis of " hypertensive crisis? " > > For years many services had protocols for such a condition, and some still > > do. However, for the last several years I have been reading literature > that > contends there's no such condition that requires treatment to lower BP > with > anything other than oral antihypertensives, and no reason to start > treatment in > the field. > > We all, I hope, understand the considerations for patients with possible > CVA, > and that it is inappropriate to lower BP in the field since there needs to > be > a CT done to determine whether or not the CVA is obstructive or > hemorrhagic. > No problem there. > > But what about patients with elevated BP and no " obvious " signs of CVA. > [OK, > can we rule out CVA in the field? What about patients with atypical CVA > presentation?] What about patients who present with > headache/nausea/vomiting and > have " elevated BP " ? What does " elevated " mean? > > I just read a physician's comment on another list that such patients > usually > have migraines. Therefore, treatment should be for the migraine and not > for > the BP. > > So, I ask the question. Is there a recognized condition/diagnosis of > " hypertensive crisis " and if so should it be treated in the field? What > are the > rules for recognizing it if it exists? What are the preferred treatments? > We > don't and can't carry Nipride very well; labetalol is fine if infused; NTG > OK > if infused but probably not OK by SL/spray. How many services carry IV > pumps and labetalol/Tridil? > > I have recently seen some protocols that address " hypertensive crisis " and > > provide BP perimeters for treatment. I'm skeptical of that approach. Isn't > > that treating " numbers " rather than the patient? > > Your thoughts? > > Gene G. > Truth-Seeker IV (ret.) > > ************** > Wondering what's for Dinner Tonight? Get new twists on family > favorites at AOL Food. > > (http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2008 Report Share Posted May 5, 2008 A hypertensive emergency is a condition where elevated blood pressure (systolic > 200, diastolic > 120) is causing end-organ changes (e.g., chest pain, AMS, shock, renal failure). The blood pressure must be lowered in hours. A hypertensive urgency is a condition where the blood pressure is high (systolic > 220, diastolic > 120) yet significant end-organ changes have not occurred. The blood pressure can be lowered over 24 hours or so. The trend is away from sodium nitroprusside and towards Labetalol and similar agents. I just read a review on this as my 10-year emergency medicine board recertification exam is next month. From: texasems-l [mailto:texasems-l ] On Behalf Of wegandy1938@... Sent: Monday, May 05, 2008 5:33 AM To: texasems-l Subject: Re: Hypertensive crisis Your experience mirrors mine. I realize we're talking semantics to a degree. Hypertensive emergency/hypertensive crisis/hypertensive urgency. Who made up those names and wrote the definitions of them? How many physicians, if presented with a questionairre about hypertension, hypertensive crises, hypertensive urgencies, and hypertensive emergencies would answer a well constructed poll in any way that would lend to any sort of enhanced understanding about this problem, if it is in fact a problem? GG In a message dated 5/5/08 3:13:58 AM, drdugud@... <mailto:drdugud%40gmail.com> writes: > > Everything I read would indicate pre-hospital treatment is contraindicated. > If, however, pre-hospital treatment is going to be provided by an EMS > provider, it should be to treat the s/s (CP, back pain, SOB, or neuro > signs), not simply to treat the numbers. We all learn in school that we > should treat the patient, not the machines. > > I couldn't find a clear definition of hypertensive crisis. I found several > inclusion criteria to diagnose hypertensive urgency and hypertensive > emergency, but nothing to truly define a " crisis " . > > Just a few early morning thoughts.... > > Neil > > > > > Is there a recognized condition/diagnosis of " hypertensive crisis? " > > > > For years many services had protocols for such a condition, and some still > > > > do. However, for the last several years I have been reading literature > > that > > contends there's no such condition that requires treatment to lower BP > > with > > anything other than oral antihypertensives, and no reason to start > > treatment in > > the field. > > > > We all, I hope, understand the considerations for patients with possible > > CVA, > > and that it is inappropriate to lower BP in the field since there needs to > > be > > a CT done to determine whether or not the CVA is obstructive or > > hemorrhagic. > > No problem there. > > > > But what about patients with elevated BP and no " obvious " signs of CVA. > > [OK, > > can we rule out CVA in the field? What about patients with atypical CVA > > presentation? presentation?<wbr>] What about patien > > headache/nausea/ headache/na > > have " elevated BP " ? What does " elevated " mean? > > > > I just read a physician's comment on another list that such patients > > usually > > have migraines. Therefore, treatment should be for the migraine and not > > for > > the BP. > > > > So, I ask the question. Is there a recognized condition/diagnosis of > > " hypertensive crisis " and if so should it be treated in the field? What > > are the > > rules for recognizing it if it exists? What are the preferred treatments? > > We > > don't and can't carry Nipride very well; labetalol is fine if infused; NTG > > OK > > if infused but probably not OK by SL/spray. How many services carry IV > > pumps and labetalol/Tridil? > > > > I have recently seen some protocols that address " hypertensive crisis " and > > > > provide BP perimeters for treatment. I'm skeptical of that approach. Isn't > > > > that treating " numbers " rather than the patient? > > > > Your thoughts? > > > > Gene G. > > Truth-Seeker IV (ret.) > > > > ************ * > > Wondering what's for Dinner Tonight? Get new twists on family > > favorites at AOL Food. > > > > (http://food.http://food. <http://food.http:/food.> <wbhttp://food.http://food. <wbhttp://food.http:/food.> <wbrhttp) > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2008 Report Share Posted May 5, 2008 Given normal transport times (< 30 minutes) would you lower the pressure in the ambulance (assuming you had labetalol) for a hypertensive emergency or just transport? GG > > A hypertensive emergency is a condition where elevated blood pressure > (systolic > 200, diastolic > 120) is causing end-organ changes (e.g., chest pain, > AMS, shock, renal failure). The blood pressure must be lowered in hours. > > A hypertensive urgency is a condition where the blood pressure is high > (systolic > 220, diastolic > 120) yet significant end-organ changes have not > occurred. The blood pressure can be lowered over 24 hours or so. > > The trend is away from sodium nitroprusside and towards Labetalol and > similar agents. > > I just read a review on this as my 10-year emergency medicine board > recertification exam is next month. > > From: texasems-l@yahoogrotexasem [mailto:texasems-l@yahoogrotexasem] On > Behalf Of wegandy1938@wegandy > Sent: Monday, May 05, 2008 5:33 AM > To: texasems-l@yahoogrotexasem > Subject: Re: Hypertensive crisis > > Your experience mirrors mine. I realize we're talking semantics to a > degree. Hypertensive emergency/hypertens degree. Hypertensive > emergency/hyper > made up those names and wrote the definitions of them? > > How many physicians, if presented with a questionairre about hypertension, > hypertensive crises, hypertensive urgencies, and hypertensive emergencies > would > answer a well constructed poll in any way that would lend to any sort of > enhanced understanding about this problem, if it is in fact a problem? > > GG > In a message dated 5/5/08 3:13:58 AM, drdugud@... < > mailto:drdugud%mailto:drdu> writes: > > > > > Everything I read would indicate pre-hospital treatment is > contraindicated. > > If, however, pre-hospital treatment is going to be provided by an EMS > > provider, it should be to treat the s/s (CP, back pain, SOB, or neuro > > signs), not simply to treat the numbers. We all learn in school that we > > should treat the patient, not the machines. > > > > I couldn't find a clear definition of hypertensive crisis. I found several > > inclusion criteria to diagnose hypertensive urgency and hypertensive > > emergency, but nothing to truly define a " crisis " . > > > > Just a few early morning thoughts.... > > > > Neil > > > > > > > > > Is there a recognized condition/diagnosis of " hypertensive crisis? " > > > > > > For years many services had protocols for such a condition, and some > still > > > > > > do. However, for the last several years I have been reading literature > > > that > > > contends there's no such condition that requires treatment to lower BP > > > with > > > anything other than oral antihypertensives, and no reason to start > > > treatment in > > > the field. > > > > > > We all, I hope, understand the considerations for patients with possible > > > CVA, > > > and that it is inappropriate to lower BP in the field since there needs > to > > > be > > > a CT done to determine whether or not the CVA is obstructive or > > > hemorrhagic. > > > No problem there. > > > > > > But what about patients with elevated BP and no " obvious " signs of CVA. > > > [OK, > > > can we rule out CVA in the field? What about patients with atypical CVA > > > presentation? presentation?<wbr>] What about patien > > > headache/nausea/ headache/na > > > have " elevated BP " ? What does " elevated " mean? > > > > > > I just read a physician's comment on another list that such patients > > > usually > > > have migraines. Therefore, treatment should be for the migraine and not > > > for > > > the BP. > > > > > > So, I ask the question. Is there a recognized condition/diagnosis of > > > " hypertensive crisis " and if so should it be treated in the field? What > > > are the > > > rules for recognizing it if it exists? What are the preferred > treatments? > > > We > > > don't and can't carry Nipride very well; labetalol is fine if infused; > NTG > > > OK > > > if infused but probably not OK by SL/spray. How many services carry IV > > > pumps and labetalol/Tridil? > > > > > > I have recently seen some protocols that address " hypertensive crisis " > and > > > > > > provide BP perimeters for treatment. I'm skeptical of that approach. > Isn't > > > > > > that treating " numbers " rather than the patient? > > > > > > Your thoughts? > > > > > > Gene G. > > > Truth-Seeker IV (ret.) > > > > > > ************ * > > > Wondering what's for Dinner Tonight? Get new twists on family > > > favorites at AOL Food. > > > > > > (http://food.http://food. <http://food.http://food> < > wbhttp://food.wbhttp://foo <wbhttp://food.wbhttp://fo> <wbrhttp) > > > > > > Quote Link to comment Share on other sites More sharing options...
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