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Hypertensive Crises

Definition and Basics

  • DBP > 120 w/ potential end-organ damage
  • Change in BP over change in time is the key not absolute BP
  • HTN + neuro sx means NO overzealous normalization
  • Decrease BP 20-25% from presenting BP

   

Ask ABCD

  • Age
  • Allergies
  • BPs (previous)
  • Current medications and what they take at home
  • Diagnostics (i.e. labs)

   

Medications  

  • hydralazine 10-20 mg PO/IV/IM q6°
    • Onset 10-20#
    • Lasts 3-8°
    • Peripheral vasodilator, CO, HR

 

  • labetalol 20 mg IV q6°
    • Onset 5-10#
    • Lasts 3-6°
    • Beta-blocker can decrease HR

 

  • enalaprilat 1.25-5 mg IV q6°
    • Onset 15-30#
    • Lasts 6°
    • ACEI, NOT in AKI

 

  • nicardipine 30 mg PO q8°
    • Calcium channel blocker

 

  • nitroglycerin 0.4 mg SL q5# ´3
    • 5-200 mcg/min IV
    • 5-10-15-20-30-40-60-80-100-120-140-160-180-200 mcg/min q3-5#
    • Onset 3-5#

 

  • clonidine 0.1-0.2 mg PO q12°
    • MAX 0.8 mg in 24°
    • alpha2-agonist, rebound HTN 
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