My department doesn't currently have a hypertensive crisis protocol. Originally, we used Procardia, changed medical directors and went with Labetalol. Once again, new medical director, revised protocols, and somehow this one was left out. I was just wondering what some of you guys may use, and what is the current drug of choice. My research on the net has turned up a little, but not a lot. Any help would be appreciated.

not sure what a Hypertensive Crisis Protocol is?? I'm damn sure we dont have one, LOL. what is it any maybe I can figure it out.

J-

Basically just a protocol for patients with a very high blood pressure, usually anything over 180/110. If the patient has chest pain we can go the whole ASA, nitro, and morphine route. This will most times take care of the chest pain and the high BP. Sometimes though, we run across someone c/o only of the high BP, and I 'm just trying to find out what is currently in use in these cases. and how you guys like what you use as far as the drugs.

gotcha, I work on the PD side so I am usually giving the chest pains and heart attacks, LOL

J-

10 years ago we used Procardia sub lingual.

In almost all cases you should do nothing in the prehospital environment for hypertension.  Maybe if you have really long transport times, then on a rare occasion you may need to intervene.  On the whole, transport w/ supportive care.  The dangers of using meds like nitro, etc for lowering BP are too far on the risk/benefit scale to warrent their use.  Also, an isolated Hypertensive crisis is almost never going to dump on you enroute to the ED.  The real question you have to ask yourself is what is causing the HTN.  If they have PMHx of HTN and are off their meds, then it's really no big deal.  If they have a head injury, or S/S of CVA then the HTN may be what's keeping them alive.  My department has relatively short transport times, our protocol is if we need emergency lowering of BP we have to call and get permission for nitro (we don't call for anything usually).

We have both NTG and Labetalol in our HTN protocol, but the Pts B/P has to be pretty high before we give them anything. I've been here 1 1/2 yrs. and haven't used either for HTN at all.

They tell us that the best thing is to NOT drop the BP in the field...must be done very carefully.  We used to drop the BP but no more.

We used to carry Procardia.

Now we do nothing.

If they are in CHF and are hypertensive we give high dose NTG: 1.6 mg SL if Diastolic is greater than 100 mmHg.

Whatever you do, you shouldn't drop the SBP more than 20% or you risk hypoperfusion.

We use Labetolol, standard dose is 20mg but we have to call for orders to use it. Our transport times are so short that we only get permission maybe half the time.

We carry Labetalol where I work now but have to call for med-control to use it.



I've been taught the same thing as AKFF though and haven't ever pushed Labetalol in the field.  In fact, I can count on one hand the number of pt's I would have even considered it on, one of which was the only hypertensive crisis with altered mental status that that I can recall- BM, mid 50s w/ Hx of HTN and non-compliance w/ meds.  BP was >300/230 (highest I've ever seen so it stuck in my head).  When we walked in he was gorped out like a zombie and was standing there in his underwear with this blank look on his face while urinating on himself and his couch.  Wife was freakin' mad about about the couch.  

Labetolol 20/over 2minutes 2 doses allowed. Must meet inclusion criteria. And our transport times are short.

we use  Labetalol