EXCELLENT LECTURE. BEST HT LECTURE EVER !
So, while I completely agree with this lecture -- one question keeps coming up over and over. What is the cutoff BP for Ms. Jones who is asymptomatic? Is it an SBP of 200? Would you send home an asymptomatic person without intervention with an SBP of 220? Which brings me to the next question: Aren't we really treating ourselves if the patient is truly asymptomatic?
I'd probably treat an SBP of 300. Otherwise, follow-up PCP.
Continuing to tell patients that they just need to see their primary care physician does wonders for patient satisfaction. Yes, a normal neurologic exam may give the patient some reassurance that they’re going to be OK, however, treating blood pressure acutely by augmenting their home regimen with a new medication or increasing the dose of one of their own medication’s is virtually harmless and actually doing something for the patient. The “not my problem“ approach often seems like it is poor care and a cop out. It may not change Acute or long-term outcomes but it still may be the right thing to do
The role of the Emergency Medicine provider is not to initiate blood pressure medication or augment their home chronic blood pressure management just to make the patient happy. There are adverse drug reactions and adverse drug interactions. Why be responsible for that just to make the patient happy? Our primary role is ruling out a hypertensive emergency. An alternative approach could be discussing outpatient management with the primary care provider and establishing a follow up appointment to tie the knot. Just MY opinion.
Jess, this is the best lecture I have heard on acute management of elevated BP. Thanks!Your style and clarity in teaching and presentation, is outstanding.Thank you Jess.
Sharon, Urgent Care Physician
thank you so much
This lecture should be sent to EVERY PCP in the country.
What you do matters.