Podcast 190 – Emergencies with a Side of Hypertension - a podcast by Scott D. Weingart, MD FCCM

The first thing to understand about Hypertensive Emergencies is that they look like emergencies

The second thing is in the short term, the only way to really fuck up non-emergent hypertension is by acutely lowering it too much

Hypertensive emergencies, hypertensive urgencies, markedly elevated blood pressure--ugggh! Hypertension is a real annoyance in emergency medicine. Folks get scared of numbers and encourage dangerous behavior because of them. It's a bit better in the ICU, where there is a filter to keep out non-emergent hypertension cases. "Hypertensive Emergencies" are a whole different bag. In these conditions, the hypertension is usually secondary to the actual emergency. So I prefer to call these emergencies with a side of hypertension.

Treatment Priorities

25% in the first hour



* Pain

* Inotropy/Chronotropy

* Arterial Vasodilation



The Meds



* Labetalol

* Esmolol

* Nitroglycerin

* Nitroprusside

* Nicardipine

* Clevidipine

* Fenoldopam

* Hydralazine Sucks



The Emergencies

ACS

SCAPE



* SCAPE Podcast



Aortic Dissection/AAA



*  Treatment of Aortic Dissection



Ischemic Stroke



* Stroke Podcast



ICH or TBI

aSAH



* Management of SAH



PreEclampsia/Eclampsia

Hypertensive Encephalopathy/Malignant Hypertension

a headache is not a hypertensive emergency unless the patient looks so bad that you are rushing her to CT

Usually (but not always) will have papilledema



Visual Changes, AMS, Confusion, Severe Headache, Coma

Tox

Sympathomimetic OD



MAO Inhibitors

Pheo

Acute Glomerulonephritis

Thyroid Storm



* Thyroid Storm Podcast



Want More Info?



* Great Htn Review Article from Paul Marik

* Fantastic post from the Strayer

* Long-Term follow-up shows hypertension in ED pts doesn't predict adverse outcome [Elevated Blood Pressures Are Common in the Emergency Department but Are They Important? A Retrospective Cohort Study of 30,278 Adults. Ann Emerg Med. 2021 Feb 9;S0196-0644(20)31363-9. doi: 10.1016/j.annemergmed.2020.11.005. ]



Now on to the Podcast...

Further episodes of EMCrit Podcast

Further podcasts by Scott D. Weingart, MD FCCM

Website of Scott D. Weingart, MD FCCM