Acute onset severe hypertension checklist.

1. STEP 4: SEIZURE PROPHYLAXIS
□ Assess deep tendon reflexes and respiratory rate
□ Check serum magnesium levels
Acute-onset, Severe Hypertension
Checklist
Diagnose Initial actions Treat
STEP 3: TREAT
□ 2 wide-bore IVs (16-18g) □ Vitals q1-2 min □ Monitor FHT
□ Monitor urine output (hourly) □ Send stat labs: CBC, LFTs, Uric acid, INR, Fib
□ Administer anti-hypertensive medication (within 30-60 min of confirmed severe hypertension):
MEDICATION LABETALOL HYDRALAZINE NIFEDIPINE
Initial dose Labetalol 20 mg IV bolus Hydralazine 5-10 mg IV bolus Nifedipine 10 mg PO
→ Recheck BP
If BP remains
elevated
After 10 min; labetalol 40 mg IV
bolus
After 10 min; labetalol 80 mg IV
bolus
After 10 min; hydralazine 10 mg
IV bolus
After 20 min; hydralazine 10 mg IV
bolus
After 20 min; labetalol 20 mg IV
bolus
After 10 min; labetalol 40 mg IV
bolus
After 20 min; nifedipine 20 mg
PO
After 20 min; nifedipine 20 mg
PO
After 20 min; labetalol 20 mg IV
bolus
→ Consult: MFM/Anesthesia/ICU/Internal medicine
STEP 1: DIAGNOSE
□ SBP ≥160 mm Hg, and/or
□ DBP ≥110 mm Hg (persistent for >15 min)
STEP 2: CALL FOR HELP
□ OB Rapid Response
□ Assign nursing roles
Administer magnesium sulfate, 4-6 g IV bolus (over 20 min)
Maintenance dose = 1-2 g/h IV infusion
1) Emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. ACOG Committee Opinion No. 767. American College of Obstetricians and Gynecologists.
Obstet Gynecol 2019;133:e174-80
2) Preeclampsia Toolkit: Improving Health Care Response to Preeclampsia (California Maternal Quality Care Collaborative Toolkit to Transform Maternity Care). 2014