On Call - Floor Emergencies

Hypertension Crisis:	(index)
DDx - Essential, Renal Disease (renal artery stenosis, acute glomerulonephritis, parenchymal disease.), Post-Op (pain, hypoxia, hypercarbia, hypothermia, ETT, excess fluid administration), Emotional Stress, Drug Withdrawl, Cocaine, PCP, Eclampsia, Preeclampsia (HTN, edema, proteinuria), Thyrotoxicosis, Pheochromocytoma (diaphoresis, palpitations, headaches, wt. loss), Acute Pulmonary Edema, Cushing Syn., Meds (oral contraceptives, estrogen, steroids, epinephrine, diet pills,...), pain, burns, stroke, ICP, Scleroderma, CVD, vasculitis, Clonidine or B Blocker withdrawl; Severe HTN - Diastolic BP > 115 mmHg   Rx 1. Nipride (aortic dissection [B Blocker with Nipride], AAA, malignant HTN [fundal hemorrhages, (delta) vision, retinopathy, papilledema, signs of volume overload, (dec)renal fct], HTN encephalopathy [vomit, headaches, confusion, coma], CVA, CNS hemorrhage, eclampsia, LV failure) 0.5-10 ug/kg/min; start 50 mg/500 cc D5W at 20 cc/hr and titrate to BP. 2.  IV NTG (MI, CHF, ?cardiac ischemia); start 10-20 ug/min, start 50 mg/250 cc D5W at 5 cc/hr and titrate prn 3. Labetalol (eclampsia, CNS pathology) 20 mg IV, then 20-80 mg IV q 10 min. to a max of 300 mg, or 1.0-2.0 mg/min - avoid in CHF or asthma 4. Diazoxide (encephalopathy) 50-100 mg IV q 10 min. to a max of 600 mg, or 15-30 mg/min; 5. Hydralazine (Preeclampsia/ Eclampsia) 20-40 mg IVPB q 4-6 hrs prn 6. ACE inhibitors Capoten or Enalapril (Scleroderma Crisis) 7. Clonidine (essential) 0.1 -0.2 mg po   Hypertensive Emergencies (diastolic BP > 120 mmHg) Needing Immediate BP Reduction - Encephalopathy, Eclampsia, Aortic Dissection, MI, unstable angina, APE, Intracranial Hemorrhage (SAH, intracerebral hemorrhage), Pheo. crisis, Clonidine Withdrawl
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