Emergencies in dermatosurgery
Biju Vasudevan, Rajesh Verma in Dermatological Emergencies, 2019
In chronic hypertensive patients undergoing surgery, stress, greater intraoperative bleeding [25], decreased duration of activity of local anesthesia [25], and greater risk of intraoperative serious adverse events [26] can occur, leading to a hypertensive crisis. Dermatosurgeons thus should be aware that elevations of systolic blood pressure (SBP above 180 mm Hg) and diastolic blood pressure (DBP above 120 mm Hg) constitute a hypertensive crisis [25,27]. Hypertensive emergency can lead to hypertensive encephalopathy, cerebral infarction, intracranial hemorrhage, acute left ventricular failure, acute pulmonary edema, aortic dissection, or renal failure [27]. Zampaglione et al. [28] reported that the most frequent presenting signs in patients with hypertensive emergencies were chest pain (27%), dyspnea (22%), neurologic deficits (21%), faintness (10.0%), paraesthesias (8.0%), vomiting (3.0%), and headache (3.0%) [29]. At times, procedure-related anxiety may lead to elevation of blood pressure above normal limits [30,31]. In asymptomatic patients, relaxation exercises or the use of an anxiolytic, where appropriate, may help relieve anxiety and lower blood pressure. In spite of basic measures, if the pressure is high and patients are symptomatic, the emergency medical system should be activated immediately [31].
Management of hypertensive emergencies in children*
Evelyne Jacqz-Aigrain, Imti Choonara in Paediatric Clinical Pharmacology, 2021
Charts of normal BP are available [2]. However “hypertension” in childhood is poorly defined: for example > 95th centile, 10 mmHg above 95th centile, and >99th centile are all used variably [3]. Table 1 shows values for “significant” and “severe” hypertension, which may be used in clinical practice as a rough guideline to BP levels which should be investigated and managed effectively [4]. A hypertensive emergency exists when there is organ damage, or impending organ damage, and is not defined in terms of the BP level, as this in itself cannot predict the severity of the problem alone [5,6]. The term hypertensive “urgency” is sometimes used [7,8] to distinguish those cases without organ damage, but with a possibility of such damage occurring in the next day or so. In practice this exact distinction is not often possible. The organs susceptible to damage include the brain, eyes, heart and kidney, with the major pathological process being fibrinoid necrosis of arterioles. “Essential” hypertension is a poorly defined entity in children. Severe hyper-tension should always initially be considered to be “secondary” in cause. Causes of hypertensive emergencies include (in rough order of frequency) reflux nephropathy, obstructive uropathy, renovascular disease, glomerular disease, polycystic kidney disease, haemolytic-uraemic syndrome, coarctation, phaeochromocytoma, Wilm’s tumour, renal dysplasia, intracranial disease and drugs [9]. Thus, renal causes predominate. Often there are no symptoms even in severe hypertension [9]. If present, these are mainly neurological: visual symptoms, facial palsy, convulsions, hemiplegia and frank hypertensive encephalopathy. Cardiac failure is more commonly found in very young children in whom neurological complications are relatively rare.
Surgical Endocrine Emergencies
Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba in Acute Care Surgery and Trauma, 2016
Hypertensive crisis in patients with pheochromoctyoma is due to high levels of catecholamine production and release. Commonly, it occurs in cases of locally advanced or metastatic disease, or it may be precipitated by anesthesia induction or direct tumor manipulation. The release of catecholamines leads to vasoconstriction and tachycardia, resulting in hypertension. Complications of hypertensive crisis include myocardial infarction, cerebrovascular accidents, seizures, cardiovascular collapse, and shock. Pheochromocytoma multisystem crisis (PMC) is characterized by hyperthermia, encephalopathy, and multiorgan system failure. Mortality rates may exceed 85% [30,43]. Recommendation: Hypertensive crisis results from excess catecholamine release. Uncontrolled hypertension may lead to significant morbidity, including multiorgan failure and death. Evidence Grade: B
The determinants of neurological phenotypes during acute hypertensive crises – a preliminary study
Published in Neurological Research, 2020
Mehmet Yasir Pektezel, Mehmet Akif Topcuoglu, Rahsan Gocmen, Bulent Erbil, Mehmet Mahir Kunt, Nalan Metin Aksu, Kader Karli Oguz, Ethem Murat Arsava
Background and Purpose: Acute blood pressure elevations lead to wide spectrum of neurologic manifestations, ranging from no overt neurologic symptoms to catastrophic events like ICH. Little is known regarding the determinants of this clinical variability. We determined clinical and imaging features of hypertensive crisis patients with normal neurological examination, ICH and posterior reversible encephalopathy syndrome (PRES). Methods: Cranial MRI was performed in patients with hypertensive urgency or emergency but normal neurological examination. Their clinical characteristics, and imaging features regarding cerebral small vessel disease were compared to ICH and PRES patients. Results: Hypertensive ICH patients (n = 58) were older, less likely to have hyperlipidemia, less commonly used calcium channel blockers, and had higher burden of chronic cSVD features in comparison to hypertensive crisis patients with normal neurological findings (n = 51). Multivariate analyses revealed cSVD burden score (p = 0.003) to be related with ICH, while higher admission blood pressure levels (p
Mean platelet volume is increased in patients with hypertensive crises
Published in Platelets, 2014
Mustafa Karabacak, Abdullah Dogan, Ahmet Kenan Turkdogan, Mucahit Kapci, Ali Duman, Orhan Akpinar
Platelets may be activated in hypertension (HT). Hypertensive crisis is an extreme phenotype of HT and HT-related thrombotic complications. We aimed to assess mean platelet volume (MPV) in patients with hypertensive crises. This study included 215 hypertensive urgency (HU) patients (84 male, mean age = 66 ± 15 years) and 60 hypertensive emergency (HE) patients (26 male, mean age = 68 ± 13 years), who were admitted to the emergency department with a diagnosis of hypertensive crises. Control group was composed of age- and sex-matched 39 normotensive patients. Blood samples were withdrawn for whole blood count and routine biochemical tests. Systolic blood pressure (BP) was significantly higher in the HE group than in the HU group (p
The Diagnosis and Treatment of Hypertensive Crises
Published in Postgraduate Medicine, 2009
Hypertension (HTN) is one of the most common chronic medical conditions, affecting nearly 72 million people in the United States. A systolic blood pressure (BP) > 180 mm Hg or a diastolic BP > 120 mm Hg is considered a “hypertensive crisis.” Hypertensive crises are categorized as either hypertensive emergencies or urgencies depending on the degree of BP elevation and presence of end-organ damage. The primary goal of intervention in a hypertensive crisis is to safely reduce BP. Immediate reduction in BP is required only in patients with acute end-organ damage (ie, hypertensive emergency). This requires treatment with a titratable short-acting intravenous (IV) antihypertensive agent, while severe HTN with no acute end-organ damage (ie, hypertensive urgency) is usually treated with oral antihypertensive agents. Patients with hypertensive emergencies are best treated in an intensive care unit (ICU) with titratable IV hypotensive agents. Rapid-acting IV antihypertensive agents are available, including clevidipine, labetalol, esmolol, fenoldopam, nicardipine, and sodium nitroprusside. Newer agents such as clevidipine have considerable advantages compared with other available agents in the management of hypertensive crises. Sodium nitroprusside is an extremely toxic drug, and its use in the treatment of hypertensive emergencies should be avoided. Likewise, nifedipine, nitroglycerin, and hydralazine should not to be considered first-line therapies in the management of hypertensive crises because these agents are associated with significant toxicities and/or side effects.
Related Knowledge Centers
- Blood Pressure
- Central Nervous System
- Urinary Tract
- Hypertension
- Circulatory System
- Antihypertensive
- Retinal Hemorrhage