blood pressure control guidelines (head bleed, dissection, AAA)

14 Dec

RAGING HYPOTHETICAL:
–you have a patient with a vessel somewhere that has either ruptured or is about to
–you call the appropriate surgeon, who is on the way, but in the meantime, what can you do?
MINIMIZE THE DAMAGE:
ICH:
–lowering to SBP 140-160 probably safe
–theory: less/slower hematoma growth
–options: nicardipine (less cerebral vasospasm)
AORTIC DISSECTION:
SBP 100-120, HR <60
–theory: reduce shear forces
–options: beta blocker (labetolol push, esmolol drip), nitroprusside
RUPTURED AAA:
–goal SBP 80-100
–theory: permissive hypotension; bleed slower, less likely to blow out the few clots they’re making

Reference(s): uptodate.com: Ruptured abdominal aortic aneurysm, management of aortic dissection, Spontaneous intracerebral hemorrhage: Prognosis and treatment, Kodama K, et al. Tight heart rate control reduces secondary adverse events in patients with type B acute aortic dissection, picture

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: