Hypertension

[hertzvanrental]

You risk an uncontrollable and potentially rapid decrease in BP by giving sublingual nitrates. With the potential for disastrous consequences. That is why hypertensive crisis is best treated in hospital. I'm only talking of symptom relief if required. You're not going to prevent end organ failure on a 5 minute ride to the ER. Morphine actually blunts vasoconstriction. Sub arachnoid bleeds and head injuries receive morphine with caution. And I'm not talking about loading someone up with 10-20mg, I'm talking 2mg-4mg to give some relief. A small dose like that is highly unlikely to be detrimental to the patient's BP

[scubanurse]

I think the general consensus was to avoid SL NTG, but rather go with a beta blocker in the field that is more easily controlled, I'm curious what your thoughts are on that hertzvanrental.

[hertzvanrental]

Difficult really but I tend to agree with ER Doc. We don't know what her BP runs at normally and some patients with known HTN won't/don't tolerate a "normal" BP. Can we predict how much of a drop in pressure there would be post iv beta blockers? And as stated before she was mildy symptomatic. I'm in no way saying the OP was wrong in their treatment, it sounds like they did a great job with the pt, just saying that it's a tricky call to make. And as ER Doc stated there didn't seem a huge urgency to treat there and then. I can't remember but did she have chest pain? If so then that may warrant iv beta blockers in the field. Out of interest do any of you guys out there perform fundoscopy in the field? Anyone checking for papilloedema? As it's part of my scope of practice then I would be checking for optic disc swelling etc etc.