Posted by David E. Hogan, FF/PM, RN

From: David E. Hogan (dhogan@CENT.COM)
Subject: Re: Hypertension
Newsgroups: misc.emerg-services
View complete thread (15 articles) Date: 1995/11/18

> 1] Should hypertension(and I am leaving the specifics
>deliberately vague) be treated in the pre-hospital setting?
> 2] If so, what agents should be used?
> 3] Do you currently have any "hypertension" protocols?

"In the presence of focal neurologic findings, pre-hospital treatment of
hypertension may be
contraindicated because a rapid or precipitous drop in BP may compromise
cerebral blood flow
and create further CNS injury."

However, working as a field medic and an RN in an ED setting I have been on both
ends of this
argument. I have seen patients treated for HTN in the field with no further
injury or situation
arising. There also is the patient that had to be intubated due to sudden
decline in his
neurological status including respiratory compromise.

I think you must certainly distinguish between the patient with an extensive
HTN hx and an
individual with a sudden, unexplained elevation in his or her BP with focal
neurologic findings
indicating that the patient is indeed symptomatic for neurological involvement.

Once in the ED I have seen patients treated with sublingual Procardia
immediately upon arrival
without any consideration for further CNS injury. Those same patients,
however, are
immediately sent to the CAT scan for definitive diagnosis of cerebral findings
pertinent to CNS
injury.

BTW, local protocols allow for Nifedipine (Procardia) 10 mgs, sublingually if:
Level I:
Diastolic Pressure > 120 or if systolic pressure > 200 with s/s of chest pain,
sob, or loc
changes.
Diastolic Pressure > 130 or if systolic pressure > 220 without accompanying s/s.

Level II:
Repeat Nifedipine 10 mg., SL
then,
Nitroglycerin, one metered dose (oral puff), 0.4 mgs sublingual.

Sam, I hope this gives you something to "chew" on. I know how these types of
"discussions"
can get. Above all we have to "do no further harm to the patient."

See Ya L8R,
David

-------------------------------------
David E. Hogan, FF/PM, RN
E-mail: dhogan@cent.com

Follow Ups:

• We just pulled our SL Procardia due to associated dangers with its use Jim fun
  • Re: We just pulled our SL Procardia due to associated dangers with its use Betty Henley
• Maybe our area is a little archaic, but the only thing we carry that _might_ work for hypertension is nitroglycerin Robert A. Ball, EMT-P
• Re: hould hypertension be treated in the pre-hospital setting - "hypertension" protocols Spencer T. Schoen

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