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-hypertension	120-139	80-89
Hypertension stage 1	140-159	90-99
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