Icm Fall Htn

Front 1

what is a HTN emergency

Back 1

1. Endo Organ damage

Brain- altered mental status
Kidney-
Heart-

2. Rapid elevation in BP
3. diastolic >115

Front 2

what is HTN urgency

Back 2

more common than an Emergency

NO end organ damage (kidney, brain, heart)

diastolic >115 (same as emergency)

Front 3

what are the CNS signs that indicate end organ damage in HTN

Back 3

1. ALTERED MENTAL STATUS
2. headache
3 vision change
4. nausea/vomit

WIll find:
1. Blindness
2. CN dysfx
3. Aphasia

Front 4

what are some signs/sx that indicate end organ damage of the heart (end organ damages caused by HTN)

Back 4

not as common end organ signs as the altered mental status

1. angina
2. MI
3. CHF
4. SOB
5. dyspnea
6. orthopena
7. peripheral edema
8. JVD
9. PND (Paroxysmal nocturnal dyspnea)
10. cardiac enzymes

Front 5

what indicated end organ renal damage

Back 5

1. hematuria/protenuria
2. problems urinating
3. decreased output
4. flank pain
5. BUM/Creatinine in BMP (basic metabolic panel)
6. renal insufficiency
7. microalbumin

Front 6

what are some good meds to give pretty much everyone, they wont really hurt ya

Back 6

1. O2
2. IV fluids

Front 7

HTN can cause:

Back 7

1. stroke
2. CHF
3. Peripheral vascular disease
4. sudden death
5. MI

Front 8

we know we cant just take BP once and call it HTN if its like 140/95, is there ever a time we can dx HTN after 1 reading

Back 8

if >180 >110 OR end organ damage

Front 9

why might you get a false + HTN reading

Back 9

wrong cuff, improper technique

Front 10

is there end organ damage in essential HTN? urgency?

Back 10

nope, end organ is only in HTN EMERGENCY

Front 11

what is MAP?
calc if BP is 200/120
what is normal limits

Back 11

Diastolic + (syst -diastolic)
______________
3

200/120 is HTN, MAP is

120+ (200-120)/3
= 147, WNL

Normal is 50-150

Front 12

HTN can be 2 to a disorger that what?

Back 12

increases CO or TPR

CO= HR x SV
MAP= D+ (S-D)/3

Front 13

what systems are affected by HTN

Back 13

1. Brain
2. heart
3. Kidney
4. endocrine

Front 14

why might someone with HTN have altered mental status. whats the physio behind it? what is the presentation

Back 14

Cerebral hyperperfusion leads to dilated arterioles, the brain cant hands the increase in pressure, the BBB breaks down, intracranial pressure increases and prevents new blood- decreased cerebral blood flow

Pt presents:
headache, nasuea, comit,

Doc Finds:
focal neurlogic defects, blindness, CN dysfx, aphasia, hemiparesis (1 sided mm weakness)

Front 15

If pt presents...
Altered mental status, headache, blindness

and doc finds...
CN dysfx, aphasia, 1 side of body weak

whats the deal? what do you need to be cautios of

Back 15

CNS involvement of HTN

**dont bring MAP down too fast, it can decrease cerebral perfusion and your pt can stroke out (brain autoregulates when MAP changes)

seen in:
old
ppl with carotid stenosis
chronic HTN

Front 16

why be careful to bring HTN down slow if its really high?

Back 16

bs of the brains autoregulation- pt may decrease cerebral BF and stroke out

**especially risky in
1. ppl with chronic HTN
2. old
3. ppl with severe carotid stenosis

Front 17

if an EKG shows ischemia w/o injury (ischemia- T inversion, injury- ST change) and they have angina what can it be

Back 17

end organ cardio damage by HTN emergency

**pt may have CHF, MI

SOB, dyspnea, orthopenia, PND (cant breath in middle of night), peripheral edema.

PE: increase RR, rales, JVD, gallop heart

Front 18

what are the changes in the fundus in acute HTN, chronic

Back 18

Acute: paplilledema, fundal hemmorage, vasospasm

Chronic: AV nicking, silver wiring, arterioler aneurysms, cotton wool exudates

Front 19

if you see cotton wool and silver wire on fundus what are you thinking?

how would your thinking change if you saw papliedema and fundal hemmorage

Back 19

Chronic: also see AV nicking, arterioler aneurysm


Acute: also see vasospasm

Front 20

if your pt has 200/120 and has serum creatinine >1.5 and protenuria 1+ what will you do

Back 20

HTN EMERGENCY

*these are signs of end organ damage of HTN (renal)

**also will have hematuria and microalbumin

Front 21

in the case what were the things that led us to believe it was urgency rather than emergency? why could we dx HTN even though we just took BP once

Back 21

No endo rogan damage

CNS: normal mentation, neuro exam normal. AV nicking

CV: no angina, SOB, peripheral edema, pulse was equal, no EKG change. CXR- clear, no pulm edema, aneurysm, coarctation

GU- no protein or blood

**can make dx bc >115 is stage 3 so we can do it

Front 22

what is essentail HTN

Back 22

no underlying cause, most ppl have essentail

Front 23

so if essential HTN is HTN w/o underlying cause, what are some underlying causes of HTN

Back 23

1. Chronic Renal Disease

2. Renal A stenosis

3. Pulmonary Aldosteronism

4. Coarctation of the Aorta

5. Cushingg's Syndrome (increase cortisol)

6. Pheochromocytoma

7. Drug induced

Front 24

how should we treat HTN urgency

Back 24

decrease BP slowly

- monitor close for 2 weeks then can go 3 months