Flashcards in Primary Care Emergencies Deck (17)
What is considered significantly elevated blood pressure?
>= 180/>= 120 mmHg
What should be included in the assessment of patients with significantly elevated BP?
acute head injury, general neurologic symptoms, focal neurologic symptoms (stroke), flame hemorrhages/cotton-wool spots/papiledema (hypertensive encephalopathy), nausea/vomiting (increased intracranial pressure), chest discomfort (MI), acute/severe back pain (aortic dissection), dyspnea (pulmonary edema), pregnancy (preeclampsia), use of drugs
What tests should be performed in a patient with significantly elevated BP?
ECG, chest x-ray, urinalysis, electrolytes, creatinine, cardiac enzymes, CT or MRI of the brain and/or chest
Why should BP be lowered gradual in a hypertensive crisis?
lowering too quickly can lead to ischemic damage in vascular beds that have grown accustomed to the higher BP
What is the exception to gradual lowering of BP in a hypertensive emergency?
acute aortic dissection - SBP must be lowered to 100-120 mmHg within 20 minutes - treat first with a beta blocker to lower heart rate and a vasodilator to quickly achieve goal BP
What should be the target for treatment of hypertensive emergencies?
gradually reduce mean arterial pressure by 10-20% in the first hour and by a further 5-15% in the next 23 hours
What is anaphylaxis?
acute, potentially lethal, multisystem syndrome resulting from sudden release of mast cell- and basophil-derived mediators into the circulation - most often results from immunologic reactions to food, medications, and insect stings
What is the most common mechanism responsible for analphylaxis?
antigen/allergen interacting with an allergen-specific immunoglobulin E (IgE) bound to the Fc-epsilon-RI receptor on mast cells and/or basophils - leads to a "chain reaction" of allergic inflammation
What are potential causes of nonimmunologic anaphylaxis?
activation of complement, direct activation of mast cells/basophils by vancomycin ("red man syndrome"), use of opiate medications, cold urticaria, oversulfated chondroitin sulfate
What are the chemical mediators of anaphylaxis?
degranulation of mast cells/basophils results in systemic release of biochemical inflammatory mediators and chemotactic substances: histamine, tryptase, chymase, heparine, tumor necrosis factor, interleukin, prostaglandin, platelet-activating factor
What are the causes of death in anaphylaxis?
circulatory collapse or respiratory arrest due to shock to heart, lungs, and vasculature - peripheral tissues continue to consume oxygen at relatively high rates leading to anaerobic metabolism and end-organ damage
What are signs and symptoms of anaphylaxis?
angioedema, itching, urticaria, SOB, stridor, syncope, rash, anxiety, periorbital edema
When should you refer to a specialist in a case of anaphylaxis?
all cases of anaphylaxis should be referred to a board-certified allergy specialist in confirmed or suspected anaphylaxis
What should be included in the history for anaphylaxis?
24-hour period before the onset of symptoms (particularly the 1-2 hours immediately preceding symptoms onset) - exposures, chronology of events, baseline health and activities, medications
What is the treatment for anaphylaxis?
What level of serum tryptase confirms a diagnosis of anaphylaxis?
> 11.4 ng/mL or elevated by at least 20% above baseline plus 2 ng/mL - blood samples should be obtained 15 minutes to 3 hours after symptom onset