Friday, September 27, 2013

EMERGENCIES ALL SHOULD KNOW:HYPERTENSIVE CRISIS(HIGH BP)

HYPERTENSIVE CRISIS:
A Hypertensive crisis  (formerly called malignant hypertension) is hypertension (high blood pressure) with acute impairment of one or more organs (especially the brain,heart,and/or the kidneys) that can result in  organ damage. In a hypertensive emergency, the BP should be slowly lowered over a period of minutes to hours with an anti-hypertensive  agent.
The brain shows manifestations of increased intra cranial pressure, such as headache, vomiting, and/or brain haemorrhage.Patients will usually suffer from left ventricular dysfunction.The kidneys will be affected, resulting in blood in urine or renal failure. 



Terminology[3]Systolic Pressure (mm Hg)Diastolic Pressure (mm Hg)
Normal< 120< 80
Pre-hypertension120-13980-89
Hypertension stage 1140-15990-99
Hypertension stage 2≥ 160≥ 100
Hypertensive crisis≥ 180≥ 120
Hypertensive emergency≥ 180≥ 120
 In most cases, the administration of an i.v SNP, which has an almost immediate BP lowering effect, is suitable (but in many cases not readily available). In less urgent cases, oral agents like captopril,clonidine,labetalolor prazocin etc. can be used, but all have a delayed onset of action (by several minutes) compared to sodium nitroprusside.



In addition, non-pharmacological treatment could be considered in cases of resistant malignant hypertension due to end stage renal failure, such as:  laparoscopic nephrectomy and renal artery embolization in refractory cases.
It is also important that the blood pressure be lowered smoothly, not too abruptly. 
The initial goal in hypertensive emergencies is to reduce the pressure by no more than 25% (within minutes to 1 or 2 hours), and then toward a level of 160/100 mm Hg within a total of 2–6 hours. Excessive reduction in blood pressure can precipitate coronary, cerebral, or renal ischemia and, possibly, infarction.
Commonly, ischemic heart attack and stroke are the causes that lead to death in patients with severe hypertension. It is estimated that for every 20 mm Hg systolic or 10 mm Hg diastolic increase in blood pressures above 115/75 mm Hg, the mortality rate for both ischemic heart disease and stroke doubles.
The latest modality of catheter based renal denervation of (renal sympathetics) helps cure REFRACTORY HYPERTENSION.  

next in blog:
HYPOTENSION
BRONCHOSPASM
FOREIGN BODY(AIRWAY)
EPISTAXIS
HYPOGLYCEMIA
ACUTE PAIN ABDOMEN
HAEMETEMESIS
THROMBOSED,PAINFUL PILES
ACUTE TUBULAR NECROSIS
PARAPHIMOSIS
TESTICULAR TORSION
TRAUMA
RENAL COLIC
PRIAPISM
ACUTE URINE RETENSION
SEVERE PALLOR
ABSCESS
ANIMAL BITES
POISONING
BURNS
SEIZURES
PARALYTIC STROKE
ANY PREGNANCY RELATED EVENT
SUDDEN LOSS OR IMPAIRMENT OF VISION
SUDDEN HEAD ACHE AND VOMITING
HIGH GRADE FEVER
NON-RESPONSIVENESS
VIOLENT BEHAVIOUR
SUDDEN CALF PAIN
SEVERE BREATHLESSNESS

1 comment:

  1. Thanks for sharing the information about the hypertensive crisis . Most of the people face High BP problem in their life .
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