Hypertensive Emergency 19


BUY THE CHEAPEST DRUGS ONLINE FROM: DrugstoreOnlineShop.com Hypertensive Emergency 1. Admit to: 2. Diagnosis: Hypertensive emergency 3. Condition: 4. Vital signs: q30min until BP controlled, then q4h. 5. Activity: Bed rest 6. Nursing: Intra-arterial BP monitoring, daily weights, inputs and outputs. 7. Diet: Clear liquids. 8. IV Fluids: D5W at TKO. 9. Special Medications: -Nitroprusside sodium 0.25-10 mcg/kg/min IV (50 mg in 250 mL of D5W), titrate to desired BP -Labetalol (Trandate, Normodyne) 20 mg IV bolus (0.25 mg/kg), then 20-80 mg boluses IV q10-15min titrated to desired BP. Infusion of 1.0-2.0 mg/min -Fenoldopam (Corlopam) 0.01mcg/kg/min IV infusion. Adjust dose by 0.025- 0.05 mcg/kg/min q15min to max 0.3 mcg/kg/min. [10 mg in 250 mL D5W]. -Nicardipine (Cardene IV) 5 mg/hr IV infusion, increase rate by 2.5 mg/hr every 15 min up to 15 mg/hr (25 mg in D5W 250 mL). -Enalaprilat (Vasotec IV) 1.25- 5.0 mg IV q6h. Do not use in presence of AMI. -Esmolol (Brevibloc) 500 mcg/kg/min IV infusion for 1 minute, then 50 mcg/kg/min; titrate by 50 mcg/kg/min increments to 300 mcg/kg/min (2.5 gm in D5W 250 mL). -Clonidine (Catapres), initial 0.1-0.2 mg PO followed by 0.05-0.1 mg per hour until DBP <115 (max total dose of 0.8 mg). -Phentolamine (pheochromocytoma), 5-10 mg IV, repeated as needed up to 20 mg. -Trimethaphan camsylate (Arfonad)(dissecting aneurysm) 2-4 mg/min IV infusion (500 mg in 500 mL of D5W). 10. Symptomatic Medications: 11. Extras: Portable CXR, ECG, echocardiogram. 12. Labs: CBC, SMA 7, UA with micro. TSH, free T4, 24h urine for metaneph- rines. Plasma catecholamines, urine drug screen. Hypertension I. Initial Diagnostic Evaluation of Hypertension A. 15 Lead electrocardiography may document evidence of ischemic heart disease, rhythm and conduction disturbances, or left ventricular hypertrophy. B. Screening labs include a complete blood count, glucose, potassium, calcium, creatinine, BUN, uric acid, and fasting lipid panel. C. Urinalysis. Dipstick testing should include glucose, protein, and hemoglobin.
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