Transport priority for hypertensive emergency?

[ERDoc]

AZCEP,

Since when do you have a lack of control giving nitrates???? You give them every 3 to 5 minutes for a reason, because they wear off that fast. :roll: That is why they are the cat's a## in CHF. If there BP crashed, you lay them down, and give them a fluid bolus!! Amazing, isn't it??? All of the time you have to read those books, I am suprised you didn't come across that :shock:

You are not able to control anything with SL nitro. There is a reason that IV forumlations are made. You are putting so much more stress on an already weakened system. Drop their pressure, lay them down, give them fluids, pressure climbing again, sit them back, etc. Supine in contraindicated in a SAH, so why put them in a position where they need to be supine.

[ERDoc]

JPINFV,

Yes, you would lower the heart rate. Do you know how you would do that?? VASODILITATION. The heart beats faster because it has to pump against an increased vascular resistance, you take that away, the heart says thanks. :?

There is no nice way to sugar coat this one. You are 100% wrong. This is basic physiology that you should have learned in your medic class (assuming you really are one). When you vasodilate, the heart will pump faster. Think of septic shock. You decrase system vascular resistance by way of massive vasodilation. To compensate, your heart rate increases. The same thing happens with vasodilation from nitrates. You increase the heart rate. To see the effects of an increased heart rate, see my last post.

[ERDoc]

Scratrat,

???????????????The BP thing.............. Start over with the whole paramedic thing, infact go get a job more suitable for yourself, like in a barber shop or something!!!

Those in glass houses, oh never mind.

[ERDoc]

AZCEP, the guy was standing, cooking, got a headache, and his nose started to bleed, he also has a hx of HTN. Apparently his gcs is 15. SAH does NOT present like this.

Yes they do. Again, you are just 100% wrong.

160mmHg is too high to let be. I can understand if this was a hem, BUT IT'S NOT!!!

Yes it is, until proven otherwise. Are you saying that it would be OK to let the pressure say high if it was a hemorrhage?

Yes , they truely are IDIOTS, and I really don't have a problem with telling them that!

I normally don't sink to the level of name calling, but you are a tool and obviously not competent. You are a danger to your pts and thankfully have a doctor to watch over you.

If I had a beta blocker, I would ask to give it. That would be the best thing to do.

That is probably one of the only things you have said that even comes close to being correct, +2 for you.

[ERDoc]

JPINFV,

Your statments are irrelevant to this case. Nitrates lower BP, and that is what he needs.

There is more to this pt than just his blood pressure and you seem to forget that. Decreasing his BP will affect his other vitals and other organ systems. You need to consider that in your treatment.

[ERDoc]

There are many medical directors, including myself, who feel that this is a dangerous practice. You might ask to give some lopressor, but if I'm on the other end of that radio, it would not be a very large dose. And the order sure as s#it wouldn't be for nitroglycerine sublingual tablets.

Read more and post less.

'zilla

Ditto

[ERDoc]

Doc,

With all due respect, your rx for any pt is subject to scrutiny, from other physicians. Just like our rx for our pt are by other paramedics. I do not have the education that you have, and do not claim to know it all. We have protocols, and for a good reason, and they are made up by people like yourself, doctors. We do not have beta blockers in our region, (yet). We only have loop diuretics, opiates, and nitrates for HTN. And we are at the mercy of the doctor on the other end of the line, as it should be. Dont think for one second because you are only 1 of 2 doctors on this forum, that your word is gold.

We use nitrates or diuretics for what might be a HTN crisis.

This is not a simple hypertensive crisis. This is SAH until proven otherwise. You would not find one competent ER doctor out there that would say, "Hey, it's just his high BP. Let's bring it down and send him home." This guy is going to get a CT and if that is negative an LP. Only then can you say it is not a SAH.

[ERDoc]

Doesn't mean they're perfect

What do you mean we're not perfect???? :x

doesn't mean we must bow down and worship

DocZilla and I will conference on this one and get back to you.

[ERDoc]

This pt is NOT presenting with a SAH, he is infact presenting with a HTN crisis.

This pt is SAH until proven otherwise (this is getting monotonous).

Go back a reread the hx. I find it highly coincidental that he got a headache at the same time his nose started to bleed. The fact that his headache went away when his nose started to bleed says it all

You're right it does say it all. This guys pressure was so high that it was able to rupture blood vessels in his nose, so there is a good chance that it can rupture blood vessels in his brain.

I have treated many pts with command ordered nitrates, and many have resolved at least some of there symtoms.

You've treated the symptoms, not the problem. So what?

[ERDoc]

Let's keep this one going. I have enjoyed watching my post count skyrocket.