This document discusses blood pressure management and defines hypotension and hypertension. It describes causes and treatments for hypotension including hemorrhage, sepsis, and drug reactions. Hypotension requires identifying the underlying cause. Hypertension classifications include prehypertension, stage 1, and stage 2. Causes of hypertension in hospitalized patients include pain, medications, drug withdrawal and underlying conditions. Treatment options focus on restarting home medications or using IV alternatives like metoprolol, enalaprilat, or hydralazine. The key in evaluating hypotension or hypertension is assessing end-organ function while treating the underlying problem.
This document discusses blood pressure management and defines hypotension and hypertension. It describes causes and treatments for hypotension including hemorrhage, sepsis, and drug reactions. Hypotension requires identifying the underlying cause. Hypertension classifications include prehypertension, stage 1, and stage 2. Causes of hypertension in hospitalized patients include pain, medications, drug withdrawal and underlying conditions. Treatment options focus on restarting home medications or using IV alternatives like metoprolol, enalaprilat, or hydralazine. The key in evaluating hypotension or hypertension is assessing end-organ function while treating the underlying problem.
This document discusses blood pressure management and defines hypotension and hypertension. It describes causes and treatments for hypotension including hemorrhage, sepsis, and drug reactions. Hypotension requires identifying the underlying cause. Hypertension classifications include prehypertension, stage 1, and stage 2. Causes of hypertension in hospitalized patients include pain, medications, drug withdrawal and underlying conditions. Treatment options focus on restarting home medications or using IV alternatives like metoprolol, enalaprilat, or hydralazine. The key in evaluating hypotension or hypertension is assessing end-organ function while treating the underlying problem.
This document discusses blood pressure management and defines hypotension and hypertension. It describes causes and treatments for hypotension including hemorrhage, sepsis, and drug reactions. Hypotension requires identifying the underlying cause. Hypertension classifications include prehypertension, stage 1, and stage 2. Causes of hypertension in hospitalized patients include pain, medications, drug withdrawal and underlying conditions. Treatment options focus on restarting home medications or using IV alternatives like metoprolol, enalaprilat, or hydralazine. The key in evaluating hypotension or hypertension is assessing end-organ function while treating the underlying problem.
Blood Pressure Management is Complicated Blood Pressure Measurements • Hypotensive – systolic <90 mmHg or diastolic <60 mmHg • “Normal” – systolic <120 mmHg and diastolic <80 mmHg • Prehypertension – systolic 120-139 mmHg or diastolic 80-80 mmHg • Hypertension • Stage 1: systolic 140-159 mmHg or diastolic 90-99 mmHg • Stage 2: systolic ≥160 mmHg or diastolic ≥100 mmHg • Hypertensive urgency – SBP >180/120 without evidence of end-organ damage • Hypertensive emergency – SBP >180/120 with end-organ damage Hypotension • Systolic <90 mmHg or diastolic <60 mmHg • Etiology – volume depletion, sepsis, anaphylaxis, drug reactions, cardiac conditions, neurological disorders, obstruction, steroid withdrawal, etc. • Need to identify the cause of the hypotension to know how to treat • Remember, a patient with a high baseline blood pressure can be hypotensive with a seemingly normal blood pressure Causes of Hypotension • #1 – Hemorrhage • #2 – Hemorrhage • #3 – Hemorrhage Shock Parameter I II III IV Blood Loss (%) <15 15-30 30-40 >40 Pulse (bpm) <100 100-120 121-140 >140 Blood Pressure Normal Normal Decreased Decreased RR (breaths/minute) 14-20 20-30 30-40 >35 UOP (mL/h) >30 20-30 5-15 Negligible CNS Symptoms Normal Anxious Confused Lethargic “Doctor, SBP is in the 80s…” • Need objective measurements – pulse, respiratory rate, UOP, hemoglobin • Need to know the history – past medical/surgical history, home medications, allergies • Need to know the hospital course – baseline blood pressure, hospital medications, surgeries, mental status, intra-op resuscitation • Need to think about possible sources of infection or hemorrhage • Need to evaluate the patient - temptation to give a 1L bolus to everybody Resuscitative Fluids • Crystalloids • Normal saline • Ringer’s lactate • Colloids • Albumin Hypotension Classification of Hypertension • “Normal” – systolic <120 mmHg and diastolic <80 mmHg • Prehypertension – systolic 120-139 mmHg or diastolic 80-80 mmHg • Hypertension • Stage 1: systolic 140-159 mmHg or diastolic 90-99 mmHg • Stage 2: systolic ≥160 mmHg or diastolic ≥100 mmHg • Hypertensive urgency – SBP >180/120 without evidence of end-organ damage • Hypertensive emergency – SBP >180/120 with end-organ damage Causes of Hypertension in Hospitalized Patients • Pain, anxiety, agitation • Bladder distention • Medications • Drug withdrawal (legal and illicit drugs) • Undiagnosed hypertension or poorly-controlled hypertension • Hypervolemia • Increased intracranial pressure (Cushing’s triad) Treatment Options in Hospitalized Patients • Surgical patients often cannot be restarted on their home meds • If available, order medications in the same class as their home meds • Commonly used IV medications – Metoprolol, Enalaprilat, Hydralazine • Other IV medications – Esmolol, Nicardipine, Labetalol • Restart home medications slowly when patients are able to tolerate diets “Doctor, SBP is in the 200s…” • Need objective measurements – pulse, respiratory rate, UOP, “pain” • Need to know the history – past medical/surgical history, home medications, allergies • Need to know the hospital course – baseline blood pressure, hospital medications, surgeries, mental status, intra-op resuscitation • Goal is to look for signs of end-organ dysfunction while trying to treat the underlying problem Questions?