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Posted by Spencer T. Schoen
In Reply to: hould hypertension be treated in the pre-hospital setting - posted by David E. Hogan, FF/PM, RN
>> 1] Should hypertension(and I am leaving the specifics
>>deliberately vague) be treated in the pre-hospital setting?
Due to to the numerous and devastating side effects, I suggest only
treating those patient who meet some criteria for a hypertensive crisis.
>> 2] If so, what agents should be used?
Procardia, NTG, Lasix, MSO4 can all be found in various protocols.
>> 3] Do you currently have any "hypertension" protocols?
Take a look at the protocols for the system that neighbors your own:
Hudson Valley Regional EMS Protocols. They cover the counties of Rockland,
Westchester, Orange, Putnam, Sullivan, Dutchess, and Ulster - New York.
The following is quoted from the protocol.
PROTOCOL 29: HYPERTENSIVE CRISIS
DEFINITION: Diastolic BP of 120 or greater in both arms with nausea,
vomiting, headache, visual symptoms.
1. Routine Medical Care per Protocol 1. [Protocol 1 is a general care
reminder]
2. O2, EKG, Monitor.
3. IV of Normal Saline at KVO.
IN THE EVENT OF COMMUNICATION FAILURE, and in the absence of localizing
neurologic signs, the paramedic may administer NITROGLYCERINE 0.4mg SL; if
condition persists, may be repeated once after 5 minutes.
MEDICAL CONTROL OPTIONS
* NIFEDIPINE 10mg punctured capsule, given sublingual or swallowed.
* FUROSEMIDE 40mg-100mg IV.
*NITROGLYCERINE 0.4mg SL.
Hope this helps!
Spencer T. Schoen MPH, REMT-P