EMERGENCIES ALL SHOULD KNOW:HYPOTENSION(LOW BP)

HYPOTENSION(LOW BP)

Hypotension is generally considered systolic blood pressure less than 90 millimeters of mercury (mm Hg) or diastolic less than 60 mm Hg. However in practice, blood pressure is considered too low only if noticeable symptoms are present.For many people, excessively low blood pressure can cause dizziness and fainting or indicate serious heart, endocrine or neurological disorders.
 
Severely low blood pressure can deprive the brain and other vital organs of oxygen and nutrients, leading to a life-threatening condition called shock. If the blood pressure is sufficiently low,fainting and often seizures occur.
Low blood pressure can be caused by low blood volume, hormonal changes, widening of blood vessels, medicine side effects,anaemia, heart problems or endocrine problems.Reduced blood volume, is the most common cause of hypotension. This can result from bleeding; insufficient fluid intake, as in starvation; or excessive fluid losses from diarrhea or vomiting. Hypovolemia is often induced by excessive use of drugs like diuretics,alpha blockers,beta blockers,nitrates,anti-depressants etc.

 Low blood pressure may also be attributed to heat stroke.It is also seen in heart failure,sepsis etc.Ortho-static hypotension, also called postural hypotension, is a common form of low blood pressure. It occurs after a change in body position, typically when a person stands up from either a seated or lying position.
Neurocardiogenic syncope is related to vaso-vagal syncope in that both occur as a result of increased activity of the vagal activity.Evaluation of neuro cardiogenic syncope is done with a tilt table test.


Hypotension also is commonly seen in old age people when they get up (repeatedly) to pass urine (prostate related)  in night time.They should get up and walk in stages so that there is enough time for body to compensate and maintain BP in old age.

Hypotension is also seen in some pregnant woman with gravid uterus and big baby due to compression of major vein in supine position.This can be avoided by lying in lateral position with tilt to left side.

The treatment for hypotension depends on its cause. Chronic hypotension rarely exists as more than a symptom. Asymptomatic hypotension in healthy people usually does not require treatment. Adding salt to a diet can relieve symptoms of mild hypotension. A morning dose of coffee can also be effective. In mild cases, where the patient is still responsive, laying the person in dorsal decubitus (lying on the back) position and lifting the legs increases venous return, thus making more blood available to critical organs in the chest and head.
Volume resuscitation,Blood pressure support with  vaso-pressor drugs,antibiotics,steroids etc.

more in blog:

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

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

EMERGENCIES ALL SHOULD KNOW:ARRHYTHMIAS (ABNORMAL HEART BEAT)

ARRHYTHMIAS:
In arrhythmia,there is abnormal electrical activity in the heart. The heartbeat may be too fast or too slow, and may be regular or irregular. A heart beat that is too fast is called tachycardia and a heart beat that is too slow is called bradycardia. Although many arrhythmias are not life-threatening, some can cause cardiac arrest.
Arrhythmias can occur in the upper chambers of the heart, (atria), or in the lower chambers of the heart, (ventricles) or junctional. 

The most common symptom of arrhythmia is an abnormal awareness of heartbeat, called palpitations.If an arrhythmia results in a heartbeat that is too fast, too slow or too weak to supply the body's needs, this manifests as a lower blood pressure and may cause light headedness or dizziness, or syncope.

Some types of arrhythmia result in CARDIAC ARREST, or sudden death.

Medical assessment of the abnormality using an ECG is one way to diagnose and assess the risk of any given arrhythmia.A slow rhythm (less than 60 beats/min), is labelled BRADYCARDIA. A heart rate more than 100/min in persons more than 15yrs of age is called TACHYCARDIA.
Congenital heart defects are structural or electrical pathway problems in the heart that are present at birth.There are multiple methods of treatment for these including cardiac ablations, medication treatment, or altering your lifestyle to have less stress and exercise. It is possible to live a full and happy life with these conditions.
When an entire chamber of the heart is involved in a multiple micro-reentry circuits and, therefore, quivering with chaotic electrical impulses, it is said to be in fibrillation.

Fibrillation can affect the atrium (Atrial fibrillation) or the ventricle (ventricular fibrillation). ventricular fibrillation is imminently life-threatening.When a heart goes into V-fib, effective pumping of the blood stops. V-fib is considered a form of cardiac arrest. An individual suffering from it will not survive unless cardio pulmonary resuscitation(CPR) and defibrillation are provided immediately. Defibrillation is performed by applying an electric shock to the heart, which resets the cells, permitting a normal beat to re-establish itself.

There are many classes of antiarrhythmic medications, with different mechanisms of action to treat arrhythmias.
Dysrhythmias may also be treated electrically, by applying a shock across the heart .
Cardioversion is either achieved pharmacologically or via the application of a shock synchronised to the underlying heartbeat. It is used for treatment of supraventricular tachycardias. In elective cardioversion, the recipient is usually sedated or lightly anaesthetised for the procedure.Defibrillation differs in that the shock is not synchronised. It is needed for the chaotic rhythm of ventricular fibrillation and is also used for pulseless ventricular tachycardia. Often, more electricity is required for defibrillation than for cardioversion. In most defibrillation, the recipient has lost consciousness so there is no need for sedation.

In specialised catheter laboratories, they use fine probes inserted through the blood vessels to map electrical activity from within the heart. This allows abnormal areas of conduction to be located very accurately, and subsequently destroyed with heat, cold, electrical or laser probes.
next in blog:

• HYPERTENSIVE CRISIS
  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

EMERGENCIES ALL SHOULD KNOW:AORTIC DISSECTION

AORTIC DISSECTION

The aorta is the large blood vessel that leads from the heart and carries blood to the rest of the body.In some cases, the dissection will cross all three layers of the aortic wall and cause immediate rupture and almost certain death. In most other cases, the blood is contained between the wall layers, usually causing pain felt in the back or flanks.

• Type A dissections involve the ascending aorta and arch.
• Type B involves the descending aorta
• It is uncertain as to why the initial tear (rent) occurs in the intima layer of the aortic wall. Aortic dissection tends to occur most commonly in men between the ages of 50 and 70.Pain is the most common symptom of aortic dissection and is often described as tearing or ripping and often begins suddenly.The pain of an abdominal aortic dissection can be confused with the pain caused by a kidney stone.The health care professional should always be suspicious of aortic dissection as one of the three major causes of chest pain that can cause death, in addition to heart attack and pulmonary embolism.
• The ABCs of resuscitation are always a priority.
• Type A aortic dissections of the ascending aorta require stenting or surgery.
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•  
• Medical management (nonsurgical) is usually preferred for type B dissection of the descending aorta, but again, each patient needs to be assessed individually as to the specific treatment suggested. Medications are prescribed to aggressively control high blood pressure to prevent further dissection and aortic injury.
• Any chest pain should not be ignored and medical care should be accessed immediately.Since the cause of the chest pain may be unknown, giving a baby aspirin to the patient is appropriate, as is providing nitroglycerin. 
• next in blog:
• ARRHYTHMIAS
  HYPERTENSIVE CRISIS
  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

EMERGENCIES ALL SHOULD KNOW:ANGINA PECTORIS(CHEST PAIN)

ANGINA PECTORIS
The term is derived from Latin; the literal meaning is "the choking of the chest;" angere, meaning "to choke" and pectus,meaning "chest."commonly called chest pain or heart attack.Angina pectoris has a wide range of clinical expressions. 
The symptoms most often associated to angina pectoris are substernal chest pressure or tightening, frequently with radiating pain to the arms, shoulders, or jaw. The symptoms may also be associated with shortness of breath, nausea, or diaphoresis. Symptoms stem from inadequate oxygen delivery to myocardial tissue. The association with Diabetes,smoking,obesity, hypertension makes the situation an emergency as it is most likely to be dangerous to heart and ones life in matter of minutes.ECG ( takes 1-2 min). can show the diagnosis in many cases. A knowledgeable patient who reports a change in the pattern or presentation of his or her symptoms should be suspected as having worsening or unstable angina.

In the setting of unstable angina or AMI, consultation with a cardiologist is warranted.He will open the closed vessel by angioplasty and stenting if needed.

next in blog:
AORTIC DISSECTION
ARRHYTHMIAS
HYPERTENSIVE CRISIS
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