WK3 - Lecture 12 - Hypertensive Urgency & Emergency PDF

DH 410 – EMERGENCIES IN DENTAL PRACTICE Lecture 12: Hypertensive Urgency & Emergency  Hypertension (HBP/HTN)  Disorder characterized by blood pressure (BP) exceeding 130/80  Most common primary diagnosis in the United States  60 million Americans affected  Approx...

DH 410 – EMERGENCIES IN DENTAL PRACTICE Lecture 12: Hypertensive Urgency & Emergency  Hypertension (HBP/HTN)  Disorder characterized by blood pressure (BP) exceeding 130/80  Most common primary diagnosis in the United States  60 million Americans affected  Approx. 70% unaware that they have HBP (HTN) WLAC Guidelines  Normal  Systolic LESS THAN 120 mmHg  Diastolic LESS THAN 80 mmHg  Elevated  Systolic 120 – 129 mmHg  Lifestyle changes OR  Weight reduction  Diastolic < 80 mmHg  Sodium reduction  Physical activity  Increased risk of  Moderation of alcohol progressing to high blood consumption pressure  Diet rich in fruits, vegetables, and low- fat dairy products  Stage I Hypertension  Systolic 130 – 139 mmHg  Advise healthy lifestyle OR  No need to dismiss  Diastolic 80 – 89 mmHg  Refer to MD  Often placed on antihypertensive medications  Stage 2 Hypertension  Systolic at least 140 mmHg  Retake vitals in 5 minutes OR  Diastolic at least 90 mmHg  If still elevated:  New patient needs medical consult  Refer to MD  Non-invasive procedures only  Uncontrolled hypertension  If returns to normal:  Recommend stress reduction protocols  Advise lifestyle changes  Caution with Epi  Untreated Hypertension  At risk for CVD, kidney damage, CVA  For each 10 mmHg increase in systolic BP above 160  30% greater risk of CVA  Hypertension degenerates cerebral blood vessels  Damages inner lining  Causes weakened walls  Weak areas trap lipids (cholesterol buildup)  Hypertensive Crisis  Systolic >180 mmHg  Hypertensive Urgency  Hypertensive Emergency OR  Diastolic >120 mmHg  Hypertensive Urgency  Symptoms  Headache (moderate to severe)  Anxiety  Shortness of breath  Tinnitus (ringing in the ears)  Edema  Epistaxis (bloody nose) – with BP > 180/110  Hypertensive Urgency  Treatment  Seat patient upright  Recheck BP in 5 minutes  Immediate medical consultation  Refer to ER/urgent care  Contact EMS if needed  Monitor BP every 5 minutes  Administer 4-6L O2 if patient complains of dyspnea  Difficult/labored breathing  Document in detail SOAP notes  No future dental treatment without medical clearance  Hypertensive Emergency  Symptoms – similar to MI or CVA – difficult to determine exact emergency  Sudden increase in BP  180/110 often as high as 220/140  Dyspnea OTHER:  Difficult/labored breathing – Altered consciousness  Chest pain – Visual loss – Seizures  Dysarthria  Difficulty speaking – Nausea/vomiting  Weakness  Hypertensive Emergency  Treatment  Treat end organ damage, i.e. MI or CVA  BLS/CPR (if needed)  Treating hypertension secondary  Seat patient upright  Contact EMS  Monitor vital signs  Administer O2 4-6L/minute  Orthostatic Hypotension  Postural hypotension  Sudden drop in BP due to change in body position  Usually from change in position form supine to sitting upright or standing  Dizziness or loss of consciousness may occur  Orthostatic Hypotension  Etiologies  Prolonged supine positioning  Illness  Medications (anti-hypertensive)  Normally hypotensive individuals  Orthostatic Hypotension  Symptoms  Dimming of vision  Decreased hearing  Lightheadedness  Orthostatic Hypotension  Treatment  Position supine with feet raised (not Trendelenburg)  Assess airway  Administer O2 4-6L/minute  Monitor vital signs every 5 minutes  If no improvement, contact EMS  Reference Malamed, S. F. (2022). Medical emergencies in the dental office. Elsevier. Little, J. W., Miller, C., & Rhodus, N. L. (2017). Little and Falace’s dental management of the medically compromised patient. Mosby. Grimes, E. B. (2014). Medical emergencies: Essentials for the Dental Professional. Prentice Hall