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Episode 938: AHA Policy on Management of Elevated Blood Pressure (BP) in the Acute Care Setting

Release Date: 01/06/2025

Emergency Medical Minute

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Episode 942: Acute Mountain Sickness and High Altitude Cerebral Edema

Emergency Medical Minute

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Episode 941: Rehydration in Pediatric Gastroenteritis

Emergency Medical Minute

Contributor: Meghan Hurley, MD Educational Pearls: Gastroenteritis clinical diagnoses: Diarrhea with or without vomiting and fever Vomiting in the absence of diarrhea has a large list of differential diagnoses, so the combination of diarrhea and vomiting in a patient is helpful to indicate the gastroenteritis diagnosis Symptom timeline is usually 1-3 days, but can last up to 14 days – diarrhea persists the longest Treatment for mild to moderate dehydration: oral or IV rehydration Begin orally to avoid unnecessary IV in a pediatric patient Administer ODT Ondansetron...

Episode 940: Laceration Repair Methods

Emergency Medical Minute

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Episode 939: Serotonin Syndrome

Emergency Medical Minute

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Episode 938: AHA Policy on Management of Elevated Blood Pressure (BP) in the Acute Care Setting

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Many patients present to the ED with elevated BP Many are referred from outpatient surgery centers or present after an elevated measurement at home Persistent questions on the best way to treat these patients The AHA published a scientific statement on the management of elevated BP in the acute care setting Hypertensive emergencies: SBP/DBP >180/110–120 mm Hg with evidence of new or worsening target-organ damage Includes aortic dissection or subarachnoid hemorrhage Require aggressive treatment Asymptomatic...

Episode 937: Pneumomediastinum

Emergency Medical Minute

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Episode 936: Etomidate vs. Ketamine for Rapid Sequence Intubation

Emergency Medical Minute

Contributor: Ricky Dhaliwal MD Educational Pearls: Etomidate was previously the drug of choice for rapid sequence intubation (RSI) However, it carries a risk of adrenal insufficiency as an adverse effect through inhibition of mitochondrial 11-β-hydroxylase activity A recent meta-analysis analyzing etomidate as an induction agent showed the following: 11 randomized-controlled trials with 2704 patients Number needed to harm is 31; i.e. for every 31 patients that receive etomidate for induction, there is one death The probability of any mortality increase was 98.1% ...

Episode 935: Pregnancy Extremis - TOLDD

Emergency Medical Minute

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Episode 934: Subendocardial Ischemia

Emergency Medical Minute

Contributor: Travis Barlock MD Educational Pearls: What is the ST segment? The ST segment on an ECG represents the interval between the end of ventricular depolarization (QRS) and the beginning of ventricular repolarization (T-wave). It should appear isoelectric (flat) in a normal ECG. What if the ST segment is elevated? This is evidence that there is an injury that goes all the way through the muscular wall of the heart (transmural) This is very concerning for a heart attack (STEMI) but can be occasionally caused by other pathology, such as pericarditis What if the ST...

More Episodes

Contributor: Aaron Lessen, MD

Educational Pearls:

Many patients present to the ED with elevated BP

Many are referred from outpatient surgery centers or present after an elevated measurement at home

Persistent questions on the best way to treat these patients
The AHA published a scientific statement on the management of elevated BP in the acute care setting

Hypertensive emergencies: SBP/DBP >180/110–120 mm Hg with evidence of new or worsening target-organ damage

Includes aortic dissection or subarachnoid hemorrhage
Require aggressive treatment

Asymptomatic markedly elevated inpatient BP: SBP/DBP >180/110–120 mm Hg without evidence of new or worsening target-organ damage AND asymptomatic elevated inpatient BP: SBP/DBP ≥130/80 mm Hg without evidence of new or worsening target-organ damage

No benefits to urgent treatment in the ED, but there are harms to treating patients in this manner
These patients do not require IV medications
Provide reassurance and instructions on following up with their PCP to manage their BP in the outpatient setting

Removed the term “hypertensive urgency”

References

Bress AP, Anderson TS, Flack JM, et al. The Management of Elevated Blood Pressure in the Acute Care Setting: A Scientific Statement From the American Heart Association. Hypertension. 2024;81(8). doi:https://doi.org/10.1161/hyp.0000000000000238

Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3

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