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Hypertensive Emergencies
from COMLEX 2 Audio Crash Course - - Complete Review for the Comprehensive Osteopathic Medical Licensing
by AudioLearn
ventilation disturbances, such as drowning, SIDS, smoke inhalation, or airway obstruction, although trauma and poisoning can play a role.
The diagnosis is largely clinical. There may be presyncopal symptoms, progressive loss of level of consciousness, or seizure. Many will have no warning whatsoever but will simply collapse. The diagnosis is made by the presence of pulselessness, unconsciousness, and apnea. Pupils will be unreactive within minutes of the event because of cerebral anoxia.
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The three rhythms most commonly seen are ventricle tachycardia, ventricular fibrillation, and asystole. Pulseless electrical activity is less commonly seen. Look at possible causes that could be treated, including hypoxia, hyperkalemia, acidosis, hypokalemia, hypothermia, hypoglycemia, tamponade, toxic ingestion, pulmonary embolism, MI, trauma, or tension pneumothorax.
Survivability depends on whether the event happened in a hospital, was witnessed, was treated with early defibrillation, had early CPR, had a rhythm other than asystole, and receive good post-resuscitative care after the event has resolved.
HYPERTENSIVE EMERGENCIES
Hypertensive emergencies in the emergency department are seen as severely high blood pressure readings along with evidence of damage to target organs, such as the eyes, brain, heart, and kidneys. Patients will sometimes present with myocardial ischemia, aortic dissection, renal failure, preeclampsia or eclampsia, pulmonary edema from heart failure, and hypertensive encephalopathy.
Very high pressures cause transudation and exudation of blood plasma into the tissues. When it happens in the eyes, you see papilledema. When it happens in the brain, you see cerebral edema. Those with intracranial hemorrhage can have high blood pressure secondary and not causative of the hemorrhage so lowering the blood pressure could be harmful to the patient.
A situation of hypertensive urgency happens with diastolic pressures of greater than 120 but no evidence of end organ damage except mild retinopathy. Emergency blood
