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musicislife

Hypertension

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I gave a report to a medic that the BP was a high, saying that it was 184/110..she said it was not high...what is considered "high"? no history involved here, just syncope and abdominal cramps.

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Normal ranges for blood pressure are pretty easily searchable. Pressure ranges and stages of high blood pressure are also pretty easily searchable. What has your research shown? You thought this was a high pressure and reported it as such. Surely you had something that made you think so. What was it?

Have you asked the medic in question why she said what she said?

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Normal ranges for blood pressure are pretty easily searchable. Pressure ranges and stages of high blood pressure are also pretty easily searchable. What has your research shown? You thought this was a high pressure and reported it as such. Surely you had something that made you think so. What was it?

Have you asked the medic in question why she said what she said?

my research from AHA says that BP is the lower end of a hypertensive crisis..but the medic said otherwise. She also left before I could ask after we transferred the PT. I was concerned because the LOC, hypertension, abdominal pain, seemed like dissecting AAA.

Edited by musicislife

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Ok. So at this point who are you going to trust more? Yourself? Especially after having verified that your concern about her BP was founded in reality... specifically that the patient's BP was, in fact, high? Or the medic who seemed to brush you off?

What other differentials did you come up with regarding this patient? Any follow up available?

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Ok. So at this point who are you going to trust more? Yourself? Especially after having verified that your concern about her BP was founded in reality... specifically that the patient's BP was, in fact, high? Or the medic who seemed to brush you off?

What other differentials did you come up with regarding this patient? Any follow up availa

i was also thinking a bowel obstruction, especially judging by the come and go nature of the pain and tachycardia...we don't get follow ups unless it is a CPR save

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why don't you give us the whole pt report in the form of a report that you would make to the ER Doc.

Sounds like the makings of a serious hypertensive crisis with complications to me.

Possible cardiac or stroke potential , or as you say with abd pain a possible AAA.

Where was the abd pain focused? radiating? steady? dull? sharp? Duration.

was was the rebound of the abd on palpation?

History of past events?

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why don't you give us the whole pt report in the form of a report that you would make to the ER Doc.

Sounds like the makings of a serious hypertensive crisis with complications to me.

Possible cardiac or stroke potential , or as you say with abd pain a possible AAA.

Where was the abd pain focused? radiating? steady? dull? sharp? Duration.

was was the rebound of the abd on palpation?

History of past events?

sorry I should have given a better report...

the pain was in her LLQ and she described it as a come and go cramp, and the whole event began about 15 min prior to our arrival, when she went syncopal..she was diaphoretic and warm, with no prior medical history and no history of a similar event. The pain would last about 10 minutes at a time. There was no rebound tenderness or radiation on the pain

the reason I am asking is because the medic seemed to brush my report off about the tachycardia (130bpm) and the hypertension. I guess I am trying to figure out why she brushed that report of, thinking maybe she knew something I didn't

Edited by musicislife

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First and foremost, this was hypertension by the textbook definition. If you visited your doctor for a routine physical and had that blood pressure, they would probably start you on a treatment plan. With that being said:

1) Many Americans walk around with a blood pressure in this range on a daily basis --- that blood pressure in itself is not considred a crisis. It is possible that the medic you encountered suffers from HTN and may have had a pressure in this range on any given day.

2) When you are in pain, it is not uncommon for your pulse rate and your blood pressure to increase. You can use that as a barometer (with other factors) to determine if someone is really in pain or faking ----- "Doctor, my back pain is a 10/10, the worst pain I have ever had !!!!" (B/P 120/64, with a pulse of 62 ------ Not likely). So, if the pt has no hx of HTN, her B/P may have just been temporarily inflated by her current illness/pain.

3) There are many more medical issues that can cause a blood pressure to be in this range, so you have to look at the whole picture and not just focus on the blood pressure alone. I would expect that many dialysis patients would have a pressure that is near this range a few hours before they receive their dialysis treatment. I would expect that someone who is morbidly obese might have this blood pressure without any other symptoms.

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You can use that as a barometer (with other factors) to determine if someone is really in pain or faking ----- "Doctor, my back pain is a 10/10, the worst pain I have ever had !!!!" (B/P 120/64, with a pulse of 62 ------ Not likely).

?? So what 'other factors' are you using to determine if you believe your patient or not?

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2) When you are in pain, it is not uncommon for your pulse rate and your blood pressure to increase. You can use that as a barometer (with other factors) to determine if someone is really in pain or faking ----- "Doctor, my back pain is a 10/10, the worst pain I have ever had !!!!" (B/P 120/64, with a pulse of 62 ------ Not likely). So, if the pt has no hx of HTN, her B/P may have just been temporarily inflated by her current illness/pain.

http://www.ncbi.nlm.nih.gov/pubmed/20926627

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