Hypertensive Emergencies and the use of Labetalol SIREMS
Hypertensive Emergencies and the use of Labetalol SIREMS PROTOCOL UPDATE JULY 2013
Definitions �Hypertensive Emergencies Situations that require rapid (within 1 hour) lowering of blood pressure to prevent or limit end organ damage. Hypertensive emergency can cause: � Inflammation and leaking of vessels � Renal failure � MI � Stroke � Hypertensive encephalopathy Headache, vomiting, altered mental status, vision disturbances, and seizures
Epidemiology and History �Hypertensive Emergencies usually occur in patients with a history of hypertension. �It often develops rapidly �Ask about the use/compliance with prescription medications Non compliance is the most common cause �Ask about the use of illicit drugs Amphetamines Cocaine Other sympathomimetics
Physical Findings � The patient may present with: Chest Pain Anxiety Headache Blurred vision Vertigo Tinnitus Dyspnea Nosebleed Muscle cramps Palpitations Seizures Wet lung sounds Altered mental status
Physical Findings �Patients in hypertensive crisis will look sick Poor General Impression �Skin color and condition can vary Hot/flushed to Cool/clammy �Strong bounding peripheral pulses �Blood Pressure elevated Systolic > 200 mm/Hg Diastolic > 120 mm/Hg � Be sure to check blood pressure in both arms in case aortic dissection is present
Treatment �Follow Patient Assessment and Initial Care Protocol �Oxygen as appropriate �Obtain vascular access �Cardiac monitor 12 lead ECG �Consider the possibility of stroke If symptoms are present, treat per stroke protocol It is dangerous to lower blood pressure during a stroke, consult with Medical Control �ALS Providers: after medical Control approval: Consider Labetalol 10 mg, IV/IO over 1 -2 minutes
Protocol � FR/BLS � Definition: Blood Pressure: Systolic >200 mm. Hg and/or Diastolic >120 mm. Hg � Management Patient Assessment and Initial Care protocol Oxygen therapy as appropriate � 1 -6 LPM by cannula: minimal distress. � 12 -15 LPM by NRB mask: moderate/severe distress with signs of hypoxia. � 15 LPM by BVM: inadequate rate/effort, severe distress, unstable. � Maintain Sp. O 2 > 94% � ILS/ALS Initiate vascular access Monitor cardiac rhythm � Obtain 12 lead EKG if applicable Consider the possibility of acute stroke � If s/s are present, follow Suspected Stroke Protocol � If the patient presents with chest pain or pulmonary edema Treat with the appropriate protocol Contact Medical Control (ILS) Consider Nitroglycerin 0. 4 mg SL with Medical Control order. (ALS) Consider Labetalol 10 mg IV/IO over 1 -2 minutes. Monitor for seizure activity
Labetalol Drug Profile � JJ-14 LABETALOL � Class: Alpha and Beta adrenergic blocker � � Description: An alpha 1 selective and nonselective beta blocker that is used for lowering blood pressure in hypertensive crisis. Onset and Duration: Onset: Within 5 minutes Duration: 3 -6 hours � Indications: Hypertensive emergencies � Contraindications: Hemodynamically unstable patients STEMI or heart failure � Adverse Reactions: Vertigo Headache Edema Fatigue Ventricular dysrhythmias Dyspnea
Labetalol Drug Profile Facial flushing Diaphoresis Bradycardia Nausea/vomiting Tinnitus � Drug Interactions: Bronchodilaton effects of beta-adrenergic agonists may be blunted by labetalol. Nitroglycerin may potentiate hypotensive effects. � How Supplied: 5 mg/m. L vials � Dosage and Administration: Hypertensive Crisis (Systolic >200 and/or Diastolic >120): Adult: 10 mg IV/IO slowly over 1 -2 minutes. Pediatric: Not recommended � May repeat dose in 10 minutes if needed (maximum 150 mg). � Special Considerations: Pregnancy class CD B/P, pulse, and ECG should be monitored continuously Monitor for signs of CHF, bradycardia, and bronchospasm
- Slides: 9