hypertension crisis 6 Management AND THERAPY

If a case of hypertensive crisis, which first had to do is do not panic. Things - things you can do before bringing the patient into the ER, among others:
 Know all signs - there are clinical signs of hypertensive crisis, such as chest pain or heart failure. Actions to lower blood pressure is not indicated before the patient was taken to hospital.
 Oxygen, a strong diuretic (furosemide), and nitrate, all of which may be given.
 In most cases, action to deal with hypertension before being taken to the hospital was not wise. In certain circumstances, reduction in blood pressure which can drastically reduce the target organ perfusion significantly.
Subsequent handling in the ER for patients with hypertension in principle is to determine the presence or absence of interference with the target organ.
 initial action (if the patient is not in a state of distress)
 Put in patients who are not depressed in a quiet room and checked again after initial examination. In one study, 27% of patients with early diastole blood pressure> 130 mmHg can decrease significantly after relaxation without special handling.
 Consider whether there are other reasons that cause increased blood pressure (such as severe pain which sometimes causes a rise in blood pressure).
Looking for the presence or absence  interference with target organ of patients  know history, physical examination, laboratory tests, other investigations.
 Patients without interference with the target organ can be moved without the provision of therapy as soon as possible, but still difollow - up in the hope that lowering blood pressure in stages. (JNC recommendations)
 misconception is that patients should not be moved from the emergency room with blood pressure is still high. So that the patients were given oral medication, such as nifedipin, with the hope to decrease blood pressure before it moved. This is not indicated and may be dangerous.
 The work done in this way may be difficult in improving blood pressure "drop". If this happens, then the target organ will experience hipoperfusi.
 Some patients may have a talent for an increase in blood pressure and takes a long time to control it but he was not familiar with the blood pressure drops rapidly, although it was the normal number.
 Patients with target organ disorders usually requires immediate action to lower blood pressure through the line quickly. Drug therapy is given depends on the organ - the organ.
 In the case of hypertensive crisis, blood pressure should not be lowered to the normal rate.
 The decrease of blood pressure can quickly lead to decrease blood flow to the brain, kidney, and / or coronary blood vessels, which allows the emergence of ischemic and infarction.
 In general, MAP should not be lowered more than 20 - 25% in the first hours of therapy. If the patient is stable, then further blood pressure can be lowered to 160/100-110 the next 2-6 hours.
 For the best results are expected, can be obtained by continuing the infusion of working quickly, can be titrated from parenteral antihypertensive medications with a continual monitoring of patients - sustained and intensive.
 blood pressure drop rapidly as indicated in the following circumstances:
 Ischemic acute myocardial
 Nitroglycerin IV
  - blockers IV
 congestive heart failure with pulmonary edema
 Nitroglycerin IV
 Lasix IV
 Nitroprusside IV
  acute aortic dissection in this situation, if possible systole blood pressure should be lowered quickly to 100 to 110 mm Hg or more lower.
 Labetalol IV
 Alternative IV with nitroprusside   - blockers (esmolol cont.)
 Injury  brain blood vessels using antihypertensive drugs are not always recommended for stroke patients with hypertension.
 Controlling blood pressure is influenced by the use of thrombolytic drugs in ischemic stroke. TD systole> 185 mmHg or diastole TD> 110 mm Hg is a contraindication to the use of tissue plasminogen activator (TPA) in the first 3 hours of ischemic stroke patients.
 latest recommendations from the American Stroke Association explains that patients with ischemic stroke and sistolenya TD> 220 mmHg or diastolenya TD> 120-140 can be lowered blood pressure approximately 10-15% (with IV nitroprusside or labetalol IV), if the patient is always monitored closely to decrease the status neurologist associated with blood pressure lower.
Intracranial hemorrhage   there is no evidence to support that hypertension trigger further bleeding in patients with intracranial hemorrhage.
Drastic reduction  systole blood pressure can reduce perfusion in the brain and increase the risk of death.
 Control to lower blood pressure by giving IV nitroprusside or labetalol IV (there are no bradikardi) is recommended when the systole TD> 200mmHg or diastole TD> 110mmHg.
 Interaction monoamine oksidade - tiramin with acute hypertension  phentolamin IV
 Pheokromositoma
 Phentolamin IV
 Labetalol IV
 Hypertension enselopati
 Nitroprusside IV
 Labetalol IV
IV Fenoldopam 
 Acute renal failure
IV Fenoldopam 
 Nicardipin IV
  - blockers IV
 Eklamsia
 Hydralazin IV
 Labetalol IV
IV Magnesium 
 blood pressure drop quickly in the ER in addition to the above conditions is controversial and should be avoided.
 In patients who initiated because of the use of drugs - illegal drugs can be given a combination of nitroprusside with α and  - adrenergic blockers.