Hypertensive Urgency vs Emergrncy

-Urgency: is increase in BP > 180 / 120 w/o any signs of target organ damage
-while emergency: is increase in BP > 180/120 w s/o target organ damage , like:

1. Flash pulm edema- do CXR
2. CVA: get CTB
3. renal failure: get BUN and Cr
4. Coronary ischemia/ infarction: get EKG and Cardiac Enzymes

Management:

 for Urgency:: goal is to decrease BP by 25% in next 24 hrs

While for Emergency : goal is to decrease BP by 10% in next 1 hr and 25 in next 3- 4 hrs

Pathophysiology:

High BP--cause damage to endothelium---> Decrease NO secretion---> further exacerbates BP

Also Due to Endothelin damage ---> there will be Capillary leakage --> causing Flash Pulm Edema

basal cistern

vasogenic vs Cytotoxic Edema

New Onset Atrial Fibrillation

http://www.aafp.org/afp/2002/0715/p249.html


emedicine: http://emedicine.medscape.com/article/151066-treatment#aw2aab6b6b3

VENTILATOR MANAGEMENT

http://www.thoracic.org/clinical/critical-care/critical-care-cases/cases/nausea-vomiting-and-abdominal-pain-with-pleural-effusion.php

Hypoxemia

If pt is getting Hypoxemia---> give High FiO2---> improving then
 does not improve---> increase PEEP: 

Pressors

1. Septic Shock: use Either Dopa or Levophed---> if u started with either of them then next of choice is Vasopressin--> if still low then add the one that u did not use before ( from Dopa or Levophed)
2. Anaphylactic Shock: Epinephrine
3. BP is low but stable, Heart failure and Pt is getting Acute pulmonary Edema / or other organ failure 2/2 Cardiogenic SHock then use Dobutamine