CARDIOVASCULAR

EMERGENCIES
Thursday, February 11th
• Updates
• EKG Practice
• Medication Profiles
• Cardiovascular Emergencies:
• Hypertensive Crisis
• Congestive Heart Failure
• MORE EKG & Medication Practice
Cardiovascular Emergencies 
• Life-threatening disorder that needs to be recognized, treated immediately
to minimize morbidity and mortality.
• Types:
• Sudden Cardiac Arrest
• Heart Failure
• Hypertensive Crisis
• Pericarditis
• Cardiac Tamponade
• Eclampsia/Preeclampsia
• AMI
• Angina
Hypertensive Emergencies
• Acute spike in blood pressure beyond body’s innate autoregulation
capacity.
• Results in target-organ damage (*kidneys)
• Occurs in those with a hx of HTN
• Common causes:
1. Noncompliance with antihypertensives
2. Use of sympathomimetics
• Untreated = renal failure, loss of vision, MI, stroke, death
Hypertensive Emergencies
Pathophysiology
• Mechanical stress on vascular walls leads to tissue damage.
• Results in vascular permeability, platelet, coagulation cascade
• Leads to fibrin clot which causes hypoperfusion to organ tissues.

What IM medication is given for hypoglycemia? What is the dose?

 Hypertension vs Hypertensive Crisis
Assessment
• H&P to determine hypertensive
emergency vs. crisis
• Differentiating symptoms: headache,
dizziness, AMS, SOB, CP, vomiting,
changes in vision
• Source of abrupt onset should be
investigated.
Treatments & Interventions
• Rapid lowering of BP (mainstay of therapy).
• Rapid-acting, titratable vasoactive IV drips: labetalol,
esmolol, nicardipine, nitroglycerin
• Lorazepam (Ativan) 2-4 mg IV or diazepam (Valium) 5-10
mg IV

What is diphenhydramine? What is the dose given pre-

hospitally?
Preeclampsia & Eclampsia
• Pregnancy-related high blood pressure disorders
• Preeclampsia - sudden spike in blood pressure.
• Eclampsia - includes seizures or coma.
• Cause is unknown.
• Poses risk for organ damage/failure, preterm birth, pregnancy loss, stroke.
• Seizures lead to coma or death.

What is the dose for Albuterol?

Preeclampsia & Eclampsia
Eclampsia
• Severe hypertension in pregnancy that requires immediate action.
• Additional symptoms: proteinuria, pedal edema
• First-line medication:
• Loading dose of Magnesium Sulfate 4g - 6g (maintenance dose
1g - 2g/hour)
• Additional antihypertensive therapy:
• Beta-blockers (only if SBP > 160 mmHg).
• Definitive treatment = delivery of the baby
CONGESTIVE
HEART
FAILURE
Heart Failure

• Functional/structural heart
disorder impairs ventricular filling
and ejection of blood
• Most have symptoms due to
impaired left ventricular function.

What is the dose for Atropine?

Heart Failure
• Causes
• Hypertension, obesity, CAD, DM, atrial fibrillation, hyperlipidemia
• Hypertension is most common cause
• Symptoms: dyspnea, decreased exercise tolerance, fluid retention,
pulmonary and peripheral edema, chest pain.
History & Physical
Symptoms
• Fluid overload (dyspnea, orthopnea,
edema, ascites)
• Fatigue, weakness, reduced cardiac
output
• Acute and subacute presentations:
• SOB at rest or with exertion,
orthopnea, paroxysmal nocturnal
dyspnea, RUQ discomfort due to
acute hepatic congestion (right-sided
heart failure).
Treatments & Interventions
• High flow 02
• CPAP
• Lasix (Furosemide) __?__ slow IVP
• Chest pain = SL Nitroglycerin 0.4 mg x 3
(if SP is >100-110 mmHg)

• Tridil 5 mcg/minute IVD

• Titrate 5 mcg/minute IVD Q 3-5 mins.
• Increase in increments of 10 mcg/minute
• No desired effect? Increase to 20 mcg/minute
 Treatments & Interventions (cont.)

• Morphine 2 mg slow IVP (CMC)

• 12 Lead EKG
• PRN orders for ETI/RSI

What is the dose for lorazepam?