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1、ManagementofHypertensionandHypotensionintheEmergencyDepartmentHypertensionHowdowemanageHypertensionintheER??HypertensionManagementintheEDAnnualCensus=78,000patientsApproximately215patientsperday40to50%haveelevatedBPreadingsuponadmissiontotheEDThatisroughly39,000patients/yrwithelevate
2、dbloodpressurereadingsintheER.FirstStep:CategorizeTypesofHypertensionFourCategoriesofHypertension-HypertensiveEmergency-HypertensiveUrgency-AcuteHypertensiveEpisode-TransientHypertensionWhatisaHypertensiveEmergency?HypertensiveEmergency-Arelativeincreaseinbloodpressurefrombaselinecom
3、binedwithTargetOrganDysfunction(TOD)NoDefinedPressureMeasurementTargetOrganDamageisevidentAlsoknownasHypertensiveCrisisorMalignantHypertensionTheMOSTSeriousformofhypertensionHowdowedefineTargetOrganDysfunction???TargetOrganDysfunctionEvidenceofDamageorInjuryto“TargetOrgans”suchastheH
4、eart,Brain,Lungs,Kidneys,orAorta.ExamplesofTargetOrganDysfunctionAcuteMI/UnstableAnginaCVAICH/SubarachnoidHemorrhageCHFAorticDissectionAcuteRenalFailureHypertensiveEncephalopathyHowdowedetermineifTargetOrganDysfunctionispresent?EvaluationforTargetOrganDysfunction1.EKG:(EvaluationforS
5、Televationordepression,newT-waveinversions,LVH,ornewLeftBBB)CXR:(CHF/pulmonaryedema,cardiomegaly,widenedmediastinum)UAorurinedip:(lookingforproteinuria,redcells,orredcellcasts)Chem8:(elevatedBUN/CRindicatingacuterenalinsufficiencyorfailure,lookforotheretiologiescausingmentalstatuscha
6、nges,likehypoglycemia)NeurologicalExam:(Evaluateforlateralizingsignsandsymptoms)FunduscopicExam:(lookingforpapilledemaorhemorrhages)7.CTHead:(onlyifneurologicalfindingsaresuspiciousforacuteCVA)DiagnosisandManagementofHypertensiveEmergencyHypertensiveEncephalopathyPathophysiology:-Los
7、sofCerebralAutoregulationofbloodflowresultinginhyperperfusionofthebrain,lossofintegrityofthebloodbrainbarrier,andvascularnecrosis.LossofAutoregulationoccursataconstantcerebralbloodflowofaboveMAP150to160mmHg.AcuteOnsetReversibleHypertensiveEncephalopathySymptoms:Headache,Nausea/Vomiti
8、ng,Lethargy,
