is a syndrome associated with an abrupt increase in blood pressure in a patient with underlying hypertension or sudden onset of hypertension in a previously normotensive individual. The absolute level of blood pressure is not as important as its rate of rise.
Pathologicaly:
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Clinical picture:
- Cardiac Cerebral Retinal Renal (CCRR) ????
Approach to the patient:
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In the ICU, therapy must often begin before a comprehensive patient evaluation is completed.
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A brief history and physical examination should be initiated to assess the degree of target organ damage (TOD) and to rule out obvious secondary causes of hypertension.
History:
History of hypertension or other significant medical disease. Medication use and compliance.
Symptoms attributable to target organ damage TOD
- A) Neurological: (headache, nausea and vomiting; visual changes; seizures; focal deficits; mental status changes).
- B) Cardiac (chest pain, shortness of breath).
- C) Renal (hematuria, decreased urine output).
Physical examination:
- Blood pressure readings in both arms.
- Signs of neurological ischemia, such as altered mental status or focal neurological deficits.
- Direct ophthalmoscopic examination.
- Auscultation of the lungs and heart.
- Evaluation of the abdomen and peripheral pulses for bruits or masses.
Laboratory evaluation of:
Electrolytes, blood urea nitrogen and creatinine, complete blood count with assessment of cardiac function and chest radiography.