Arterial Hypertension is a devastating illness, against which we better get ready to control it - Patient and family awareness needs more effort from providers. A companion is Respiratory Distress to recognize and manage in ER

1. 14 - September - 2012 Prepared By Dr Gamal Soliman 1
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
EMERGENCY MANAGEMENT
HYPERTENSIVE CRISIS,
RESPIRATORY DISTRESS

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
OBJECTIVE
1. To reduce blood pressure to acceptable limits-
as rapidly and safely to prevent further hypertensive
episodes.
2. To reduce the possiblity of complications.
3. To use minimum of drugs.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
POLICY
1. Hypertensive BP parameters crisis is
a severe fixed elevation of the resting arterial pressure which may
produce vascular necrosis as diastolic pressure exceeds 140
mmHg.
2. Hypertension is assessed by the following reasons.
Blurring of vision
Throbbing headache
Confusion, transient facial defects
Irritability Seizure

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3. It may be classified as:
Essential (Primary) – Sustained BP
elevation with no known case.

5. 14 - September - 2012 Prepared By Dr Gamal Soliman 5
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Malignant – An accelerated form of hypertension
in which there are hemorrhages and exudates
in the fundi,
and a diastolic pressure of 140 mmHg.
Secondary – Elevation of BP is related to
a specific disease process.
Hypertensive encephalopathy –
Usually accompanies a sudden increase in BP
and in manifested by headache, nausea,
vomiting, apprehension, confusion, or seizures.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
4.4. Hypertensive emergenciesHypertensive emergencies
include:include:
Malignant hypertensionMalignant hypertension
Hypertensive encephalopathyHypertensive encephalopathy
Hypertension complicated by CHFHypertension complicated by CHF
or aortic dissectionor aortic dissection
Hypertension in the face of acuteHypertension in the face of acute
M.I.M.I.
Toxemia of pregnancy.Toxemia of pregnancy.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
5.5. Patients with hypertensive crisis,Patients with hypertensive crisis,
severe hypertension that does notsevere hypertension that does not
respond well to treatment,respond well to treatment,
and hypertension complicated byand hypertension complicated by
organ failure should be admitted.organ failure should be admitted.

8. 14 - September - 2012 Prepared By Dr Gamal Soliman 8
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
MATERIALS &
EQUIPMENT
1. BP apparatus
2. Cardiac monitor
3. ECG machine
4. Emergency medications
as ordered
5. I.V. fluids via infusion
pump

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
PROCEDUREPROCEDURE RATIONALERATIONALE
1. Obtain1. Obtain historyhistory of the patient'sof the patient's
presentpresent
illness, including nature of onset andillness, including nature of onset and
length and severity of symptoms.length and severity of symptoms.
1. To provide1. To provide data baselinedata baseline..
Patient's often decrease orPatient's often decrease or
stop their medicationstop their medication
completely when they havecompletely when they have
been asymptomatic for abeen asymptomatic for a
period of timeperiod of time.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
9. Maintain intake and output.9. Maintain intake and output. 9. To ensure9. To ensure
prevention of fluidprevention of fluid
overload.overload.
10. Record all procedures and medications.10. Record all procedures and medications.
10. For proper documentation.10. For proper documentation.
11. Instruct the patient and family to11. Instruct the patient and family to
eliminate foods high in sodium.eliminate foods high in sodium.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
12. Control weight and maintain
low-
cholesterol diet
12. To reduce cardiac risk
factors.
13. Encourage the patient to
comply with
his medication.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
RESPIRATORYRESPIRATORY
DISTRESSDISTRESS

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
DEFINITIONDEFINITION
Respiratory failure isRespiratory failure is
an alteration in the function of the respiratory systeman alteration in the function of the respiratory system
that causes the PaO2 to fall below 50mmHg (hypoxemia)that causes the PaO2 to fall below 50mmHg (hypoxemia)
or the PaCO2 to rise above 50mmHg (hypercapnia)or the PaCO2 to rise above 50mmHg (hypercapnia)
as determined by arterial blood gas (ABG) analysis.as determined by arterial blood gas (ABG) analysis.
It is classified as acute, chronicIt is classified as acute, chronic
or combined acute and chronic.or combined acute and chronic.
AcuteAcute – characterized by hypoxemia– characterized by hypoxemia
or hypercapnea and acidemia (pH less than 7.35).or hypercapnea and acidemia (pH less than 7.35).
ChronicChronic – characterized by hypoxemia– characterized by hypoxemia
or hypercapnea with a normal pH (7.35 – 7.45).or hypercapnea with a normal pH (7.35 – 7.45).

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
OBJECTIVE
1. To assess cardiac and
respiratory status.
2. To initiate respiratory life
support system if necessary.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3. Initiate measures to relieve respiratory distress.
4. To correct hypoxemia and acid-base imbalance.
5. To provide adequate oxygenation of blood.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
POLICYPOLICY
1.1. Respiratory distress is life-threateningRespiratory distress is life-threatening
and must be treated as medical emergency.and must be treated as medical emergency.
2.2. Resuscitation equipment must beResuscitation equipment must be
ready at bedisde and ready for intubation.ready at bedisde and ready for intubation.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3. A blood gas analysis
must be obtained immediately.
4. Oxygen therapy must be administered via
face mask to relieve hypoxia and dyspnea.
5. I.V. fluids must be administered as ordered.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
6.6. The patient must maintain an upright position,The patient must maintain an upright position,
head and shoulders up.head and shoulders up.
7.7. Emotional support and reassuranceEmotional support and reassurance
must be provided as respiratory distressmust be provided as respiratory distress
may be terrifying to the patient.may be terrifying to the patient.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
8. Assessment and observation of
patient's condition:
Wheezing, rales or rhonchi
Severe dyspnea, tachycardia
Frothy, blood-tinged sputum
Edema peripheral or around the
eyes
Signs of heart failure
Altered level of consciousness
Cyanosis, diaphoresis

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
MATERIALS & EQUIPMENT
1. Oxygen
2. Face mask or Nasal
cannula
3. Blood samples for ABG
4. Airway
5. I.V. fluids as ordered.
6. Medications, I.V.
medications as ordered
7. Suction machine
8. Ventilator, if indicated.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Assess patient's condition and
report
the following signs and
symptoms:
2.1 Wheezing, rales and rhonchi
2.2Severe dyspnea, tachycardia
2.3Frothy, blood-tinged sputum
2.4Edema, peripheral or around
the eyes
2.5Signs of heart failure
2.6Altered level of
consciousness
2.7Cyanosis, diaphoresis

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3. Provide airway:3. Provide airway:
3. To reduce respiratory3. To reduce respiratory
distress.distress.
3.13.1 Elevate the headElevate the head
3.23.2 SuctionSuction
3.33.3 HumidificationHumidification

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
4. Administer oxygen via face mask
4. To relieve hypoxia and
dyspnea.
5. Ventilate the patient as ordered
5. To normalize pH.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
5.15.1 InsertInsert
endotracheal tubeendotracheal tube
5.25.2 Attach toAttach to
ventilator asventilator as
indicatedindicated
5.35.3 Suction theSuction the
patient's secretionspatient's secretions.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
before all,before all,
No obstaclesNo obstacles

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A