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Hypertension

Rob Orman, MD and Rob Rogers, MD
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EM:RAP February Written Summary 1 MB - PDF

In this edition of " Notes from the Community" Rob Orman is joined by Rob Rogers to discuss Hypertension in some of its many presentations.. You can not swing a cat in the EM:RAP studios without hitting a Rob or Two...

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Kevin M., MD -

Very informative lecture. I wasn't aware of the increasing role of Nicardipine and it's correct dosage regimen.

Agree completely on the use of NTG drip in hypertensive CHF pt's.It's worked wonders for me over the years.

I wish some mention had been made of two issues. Manual v. Machine BP readings, and the importance of doing a COMPETE examination, including vascular on the hypertensive patient who is elderly, ill-appearing or in severe pain

Mike J., M.D. -

Gentlemen,

Thanks for the rational review! And thanks for the particular parsing of Urine vs Creatinine. This came up recently at out group meeting and no one could agree on what to do.

Question though,
Nicardipine for Acute Decompensated CHF?????

Helene C., M.D. -

Is nicardipine availlable in Canada ??

Brooks W. -

Just had a type B aortic dissection in the ED, started esmolol, got up to 200µg/kg (our hospital max) without making a real dent in the BP. Had to add nitroprusside.

Is this atypical?

the cardiologist was growling behind me "You shoulda started Nipriide first..."

EMCrit -

Brooks, the esmolol is not for the BP, it is to control the heart rate. Each beat rips, the final beat kills. Titrate esmolol solely to get HR < 60. Once that happens, then you add nicardpine for BP, or if you don't have it, then nipride. Never nipride first,the heart rate will shoot up.

but before any of that, get the patient to the point of relaxation with fentanyl; this may take a bunch of fentanyl.

Kurt T., P.A. -

Dr. Matu says shouldn't give IV b-blockers and Ca-blockers, possible complete block, your thoughts Scott.?

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