Case Based Presentation_ Hypertension in the ICU课件.ppt

Case Based Presentation:Hypertension in the ICU By Noemie Chessex and colleagues UBC Case A 19-year-old man presents to ED with episodic headaches that resolved spontaneously. In the last week, the headaches have become much more severe and frequent, occurring almost daily, and are accompanied by throbbing chest pain, sweating, dizziness and palpitations. Case On arrival in ED, the pt is complaining of a severe headache, BP is 235/135 mm Hg, HR 90. He has profuse sweating and is complaining of dizziness and chest pain. ECG shows non-specific ST depressions. Question 1 Define hypertensive urgency and hypertension emergency. What are some clinical findings associated with hypertensive emergenices? (Ibrahim) Definitions: Hypertensive Crisis (Severe Htn) Hypertensive Urgency: SBP 180 or DBP110 w/o TOD Hypertensive Emergency (Malignant Htn): SBP 180 or DBP110 (esp 120) or accelerated htn wt TOD TODs: Brain: Hypertensive encephalopathy/edema, ICH, ischemic stroke Retina: Grade IV retinopathy (papilledema) CVS: ACS, Acute pulmonary edema, CHF, Aortic dissection Kidneys: accelerated nephrosclerosis, nephritic syndrome Blood: MAHA, HELLP Pregnancy: HELLP, Ecclampsia Clinical Findings Of predisposing disease Thyrotoxicosis/Thyroid storm, Hypothyroidism/Myxedema, goiter HPT: hypercalcemia (psychosis, constipation, inc QTc, cataract, nephrocalcinosis, N-DI, dystrophic calcifications of soft tissue (X-ray) Cushing’s: Cushinoid Conn’s: hypokalemic metabolic alkalosis Pheochromocytoma: perspiration, palpitation, pain (chest, h/a, AP), labile pressure (+/- orthostatic hypotension), pallor RAS: Renal bruits OSA/Pickwikian Syndrome: Obesity wt think/short neck, day time somnolence, apnea attacks Pregnancy: HELLP, Ecclampsia (edema, protienuria, sz, inc DTR) Clinical Findings Of Complications/TOD Brain: H/A, N/V, meningism, FND, delirium, decreased LOC, seizures, coma Retina: blurred vision, papilledema (IV) +/- cotton wool exudate, flame shape hg, AV nipping and silver wir