CTXMEDIC Posted January 24, 2009 Share Posted January 24, 2009 I have no problem with the other meds listed. I was aiming more at those that have NO protocol for treating hypertension in the absence of any other symptom. Cant tell you how many times EMS brought a patient to the ER with B/P of 280/140 or higher with no treatment, because they didnt have a protocol. And I am not talking about people who have a pressure of like 200/100 --- but in the extremes above that, we should be treating. If you dont have a protocol in place, dial-a-doc and ask for orders. if you just dont carry effective meds/tools i guess your patient is just screwed. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted January 24, 2009 Author Share Posted January 24, 2009 ok, We don't have a set protocol on this but I aim to have one soon if I have anything to do with it. We carry labetalol, lopressor, nitro in paste/spray/drip form. I started a Nitro drip on this guy. I also had started an inch of nitro paste which I removed on starting the drip. We flew him to the city and I have no idea how he did but I do know is pressure never went down even with Nitro at nearly 40 mcg/min. By the time the nitro was at that rate they were at the receiving hospital. He never experienced stroke like symptoms, no nosebleed and his headache only started with the nitro admin. Did I mention this guy was only 25 years old. Link to comment Share on other sites More sharing options...
ERDoc Posted January 25, 2009 Share Posted January 25, 2009 I have no problem with the other meds listed. I was aiming more at those that have NO protocol for treating hypertension in the absence of any other symptom. Cant tell you how many times EMS brought a patient to the ER with B/P of 280/140 or higher with no treatment, because they didnt have a protocol. And I am not talking about people who have a pressure of like 200/100 --- but in the extremes above that, we should be treating. There is no protocol for it because there is no need to treat it, especially in the field. Link to comment Share on other sites More sharing options...
CTXMEDIC Posted January 25, 2009 Share Posted January 25, 2009 There is no protocol for it because there is no need to treat it, especially in the field. The patient is hypertensive for sure. but with the s/s provided, its not a hypertensive 'crisis'. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted January 25, 2009 Author Share Posted January 25, 2009 The patient is hypertensive for sure. but with the s/s provided, its not a hypertensive 'crisis'. That's true CTX it wasn't a hypertensive crisis but with all the other signs and symptoms on this guy I should have labeled it Hypertensive MI CHF Pulm Edema you do the math. But then again the subject line does not lend itself to that long a subject. He truly was sky high on the BP and the MI and the chest pain and the pneumonia and the congestion andall that got me to looking for a htn crisis protocol in our book and there is none. So I have devoted the next two to three weeks to get this protocol set up. I've already received 2 protocols from people and I plan on presenting the best one to my medical director. I do appreciate all the responses. One thing I do question is what danger to the patient is there when his bp is so high, he's having an MI and we drop the pressure with meds. What happens to the heart and it's components when we drop the bp? Is it detrimental to the patient to go from 250/173 to 180/100 or 180/90? Our hospital does not even have a cardiologist so I think the patient was best served by going to the regional cardiology center. Link to comment Share on other sites More sharing options...
ERDoc Posted January 25, 2009 Share Posted January 25, 2009 CTX, I am going to assume that you were referring to the pt posted by crotchity because I would agree that even with a BP that high it is not conisdered an emergency but could be an urgency. The original pt presented by Ruff is in hypertensive emergency (or crisis). This is one situation where you would want to drop the blood pressure signifiacntly because it is causing end organ damage. You would want to drop the pressure by 10-20% in the first hour. I'm not a big fan of using Nitro for pressure control because of the reflex tachycardia. I'd much rather use a beta blocker or CCB which can also give me rate control. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted January 25, 2009 Author Share Posted January 25, 2009 ok ERDoc, let me ask you this. 2 hospitals 1st hospital small in size, 6 bed ICU, no physician at that facility has really the expertise to handle a hypertensive crisis nor a MI nor pulmonary edema in the long run. (they ship most of these types of patients to the city) 2nd hospital - 70 miles away, cardiac care unit, heart center, stroke center and the like. They can handle anything and everything that they are sent. They are a major receiving facility from all over the Eastern portion of Kansas and the Western portion of Missouri. I assume I know the answer but would it have been appropriate to take the patient initially to the 1st hospital only to probably have the 1st hospital ship the patient on to hospital 2 or should a helicopter be utilized to take the patient directly to the 2nd hospital. I made the choice to fly him to the 2nd hospital and I don't regret my decision to do so. Your thoughts. Link to comment Share on other sites More sharing options...
DartmouthDave Posted January 25, 2009 Share Posted January 25, 2009 Hello, In most urban and suburban setting treating HTN is problematic. Really, there are many reason for HTN and in some cases it may be essential. Recently, I saw a Lt. MCA who had their BP dropped in to the mid 140's from 200 or so. Bad idea. I know many will disagree with me. Or, see my example as self serving. But, the point remains that treating HTN outside the hospital in most cases strikes me as a bad idea. Cheers Link to comment Share on other sites More sharing options...
CTXMEDIC Posted January 25, 2009 Share Posted January 25, 2009 CTX, I am going to assume that you were referring to the pt posted by crotchity because I would agree that even with a BP that high it is not conisdered an emergency but could be an urgency. The original pt presented by Ruff is in hypertensive emergency (or crisis). This is one situation where you would want to drop the blood pressure signifiacntly because it is causing end organ damage. You would want to drop the pressure by 10-20% in the first hour. I'm not a big fan of using Nitro for pressure control because of the reflex tachycardia. I'd much rather use a beta blocker or CCB which can also give me rate control. yeppers...something like 20 of labetalol.. Link to comment Share on other sites More sharing options...
CTXMEDIC Posted January 25, 2009 Share Posted January 25, 2009 Can anyone quote me their protocol for hypertensive crisis. I just ran one, initial blood pressure 249/175 pulse 128 headache cough I went thru our protocols and found that we do not have a hypertensive crisis protocol. By the way the guy was also in CHF and having a MI to boot. Elevation in leads v1-v5 definitley fly this dude out. Link to comment Share on other sites More sharing options...
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