Hypertensive Emergency (Common Cross-Cover Calls)

An overview of how to approach calls regarding elevated blood pressure while cross-covering on inpatient medicine. The distinction between hypertensive emergency and urgency is covered, as well as some of the differences between various anti-hypertensives appropriate when treating acute hypertension.

[@StrongMed]

So this video is relatively old by this point. If I were to remake it, the biggest revision would be to no longer recommend IV antihypertensives for hypertensive "urgency" (i.e. no symptoms or evidence of end-organ dysfunction) irrespective of how high the number is, with a few notable exceptions (e.g. pregnancy, recent neurosurgery). In particular, IV hydralazine is almost never the best choice of anti-hypertensive.

[@magedabuldahab7481]

Good point to mention Aortic dissection in hypertensive emergency, cuz if diagnosis is delayed till patient's BP is tanked, mortality rate increases exponentially, remember John Ritter case 2003 " aortic dissection", and nice to mention the 2 confusing emergencies namely, NEurolyptic malignant syndrome and serotonine syndrome as both increase the 4 vital signs esp. temperature not only BP, remember the case of Libby Zion 1984

[@Stonefalconetti]

The intro music.... It's like "welcome to hypertensive hell, you lowlings!!"

[@conqueror445]

😂😂😂😂

[@carorb6893]

Very good videos! thank you very much for your time and efforts!

[@drnikithavalluri1781]

Thank you so much Dr. Eric It's very clear and useful

[@skulqerX]

Thank u so much dr Eric for all of ur vids. Really hope ur doing well .

[@jeremiah160]

Fantastic video! Thank you!!!

[@mayohospital830]

Thank you sir for sharing for such an informative & wonderful video... Learnt a lot & solved many queries 😀

[@giobasta6918]

This video is of inestimable value to me. Thank you for sorting videos out in playlists. This makes the navigation of your fantastic KZbin channel so much easier =)

[@HafizahHoshni]

Simply excellent. Very grateful for clear, concise and well presented video. Thank you for the great channel. 😊😊 30/8/2019

[@noureenmurtaza3255]

thanks for quick review of imp topic..really good

[@charlesamuyunzu9600]

Great summary. Thanks

[@HafizahHoshni]

Very helpful! Thank you for this explanation. You are the best! 20/2/2019 😃😃

[@armeneskandari7221]

Amazing work Dr. Strong, loved the beeper sound and text :) Quick question, is it correct to say that in absence of significant diuresis furosemide has little effect on BP?

[@niss2nice]

awesome video

[@alikemalilhan921]

Awesome presentation excellent ideas. Thank you Doctor. We are impatiently waiting for videos about Obstetric and Gynecology

[@StrongMed]

Thanks. Unfortunately, it's going to be a long wait for O&G vids. My clinical work is at a hospital for military veterans, so my personal experience with O&G is literally limited to the birth of my own kids. If there is an obstetrician/gynecologist out there who would like to contribute some videos, or has some material already made but no platform to share it, I would love to talk to them!

[@shyamalyashodarasrikantha8589]

Excellent lecture Thank you very much

[@yasmeenazan7816]

Very helpful thanks

[@adilsheikh4956]

Good explanation Sir

[@Anaben11]

great video! Could you do an update on how acute Hypertension should be treated (or not) in the Emergency Department?

[@baderguitar5848]

very good lecture

[@nakkavenkatesh2992]

Thank you

[@asitdas4692]

Wonderful

[@fowsiyadhiblawe6367]

Thanks sire. Can you tell me which fluids not give patient of hypertension ?

[@DrRoton-ln5br]

Excellent work! Easily understandable. Hope it will be continued Sir.

[@StrongMed]

Thank you. This series on "Common Cross-Cover Calls" has been superseded by my Intern Crash Course, located here: kzbin.info/aero/PLYojB5NEEakUXq0Dr5BqJsbt3MJdb7RsZ

[@shecat1964]

What is the advice for your average person who goes to get a blood pressure check and gets a reading of 205/110? Past history of high blood pressure but had been fine for years. with no meds needed.

[@nomadicrn7674]

Should Medical Charts have a "Baseline" blood pressure section added in the patient's History? (Such as with height and weight/ allergies etc) so that this information follows them for reference during medical stays/visits?

[@newbox2178]

Thanks

[@StrongMed]

Yes, that's correct.

[@ayubraywer9266]

@Strong Medicine In Kenya,Africa please post more videos on Internal and FORENSIC MEDICINE

[@ellahosokawa4663]

GODBLESS nice 👍

[@khmoh2370]

Thank you... We need doses also plz.

[@diabmaree55]

Thanks you very much strong but we wish to have pdf of this great lectures please..

[@peaceful865]

I haven't seen any role of ccb like amlodipine and ACI/ARB here?? Seen with 2x speed, did i missed smthing?

[@StrongMed]

Neither oral CCBs (e.g. amlodipine) nor ACEIs/ARBs (which are all oral) should be used in the management of hypertensive emergency since their onset of action is too delayed. The immediate management of hypertensive emergency should rely almost solely on intravenous meds, with the occasional use of sublingual nitroglycerin when an IV is not yet placed or the patient is experiencing concurrent chest pain.

[@husseinaskar9062]

what about the treatment hypertensive emergency or urgency in pt with ESRD.if there is no volume overload?

[@StrongMed]

Hussein Askar Sorry, just saw your question now! In general, the overwhelming majority of patients with ESRD who experience hypertensive crises are volume overloaded, and their BP will improve with dialysis (or diuresis, if still making urine). This is frequently true even in patients who lack the classic signs of hypervolemia (e.g. lower extremity edema, crackles, etc...). In the uncommon event that there truly is no evidence of volume overload (including IVC collapsibility on bedside ultrasound), I would approach hypertensive crises similarly to a patient with normal renal function.

[@usmle2232]

Hey strong medicine excellent lectures can u please give pdf of these lectures

[@abowajdanalr]

What about the treatment of blood pressure above 140/90 and below 180/110 in emergency room ?

[@StrongMed]

abowajdan2009 al.r Given that there are plenty of reasons someone's BP could be mildly-moderately elevated in the ER (e.g. pain, anxiety, drug intoxication/withdrawal, etc...), I would not generally start treatment, unless: 1. Asymptomatic hypertension was the reason for the ER visit, in which case I would approach the patient in the same way as in a routine outpatient with newly diagnosed hypertension (see my separate video on antihypertensives) OR... 2. The patient was experiencing symptoms/signs related to BP, such as shortness of breath in the setting of CHF, severe MR, and moderate HTN. With symptoms/signs of end-organ dysfunction, this would classify as a hypertensive emergency, which isn't very common at relatively modest BP elevations. However, if you are convinced there is a link between the BP and the patient's pathophysiology, I would approach it the same way as any other patient with hypertensive emergency (e.g. according to the flow chart, and the medication chart in the video).

[@sarahdarwiche8580]

What is the piano/organ(?) piece at the start???? 😍 Please let me know

[@caterscarrots3407]

Prelude in C minor from Book I of the Well Tempered Clavier by Bach

[@Kareemo227]

Why is captopril bad for hypertensive emergency?

[@Carmen0777]

My blood pressure is so high 183/130 I don’t know what is the cause. I have bad headaches and eyes is burning.

[@StrongMed]

If not obvious, I recommend that you speak with a doctor in person about your blood pressure and symptoms. Unfortunately, I can't give specific, individualized medical advice here.

[@Dr.everything4307]

Please go to a doctor :)

[@Gamer_Onnn]

what is the drug given for patient if he has fallen unconscious under stress with raised bp..??

[@StrongMed]

I'm not sure I know what drug you're talking about. Are there any more details about it?

[@Gamer_Onnn]

yeah his bp is measured as 150/100,how can we asses his etiology and severity of disease and drug to be prescribed

[@agpdc]

post video on new htn guidelines 2017

[@StrongMed]

That's a great request, and one that is definitely deserving of a video. However, I think I'm going to wait a few months for the dust to settle - the new AHA/ACC guidelines are proving very controversial (partially because they relied heavily on the seriously flawed SPRINT trial). I'd prefer to hear as many opinions as possible before stating anything too definitive-sounding in video format.

[@waleedal-asadi3841]

tackaaaaaaaaaaa

[@mdkarim1446]

Very good videos! thank you very much for your time and efforts!