SAQ 125 – Cardiovascular – severe hypertension with headache

Review Completed

Marked out of 12.00

A 65 year old woman presents with a severe headache.

She is otherwise asymptomatic and takes no regular medications.

Her observations are: BP 245/130 mmHg, HR 80 bpm, respiratory rate 18 bpm, temperature 36 C, oxygen saturation 100% room air, GCS 15.

List four (4) key examination findings to seek on your examination. List why each sign is important.

(Marked out of 4.0)

/ 4

List four (4) drug options for the management of her blood pressure. For each state your initial dose and route.

(Marked out of 8.0)

/ 8

Total Score: 0 / 12

Percentage: 0%

Examination finding	Why is this sign important?
Papilloedema	Raised intracranial pressure.
Meningism / neck stiffness	Raised intracranial pressure or subarachnoid haemorrhage.
CN III palsy	Suggests aneurysm.
Renal artery bruit	Renal artery stenosis.
Renal mass	Renal cell carcinoma.
Adrenal mass	Possible endocrine cause.
Cushing syndrome features	Leads to possible underlying diagnosis.
Hypertensive retinopathy	End-organ effect of longstanding hypertension.
LVF or fourth heart sound	Congestive cardiac failure.

Drug option	Dose / route
Labetalol	10-20 mg IV bolus repeated every 10 minutes until target BP obtained, then 1-2 mg/min infusion.
Hydralazine	5-10 mg IV bolus repeated 10-minutely.
GTN	300-600 mcg sublingual, followed by infusion 5 mcg/kg/hr titrated to response.
Phentolamine	1-5 mg boluses to maximum 15 mg.
Nifedipine	60 mg QID orally.
Morphine	2.5 mg boluses every 5 minutes.