Intern Survival Series: Dyspnea and Hypertension in hospitalized patients

Aug 17, 2011Dan Waldman

Dyspnea: Main Goals Organized thought Process

“Dyspnea” vs “Hypoxia”

“Anchor Bias” in dyspnea

Thoughts on PE

Case Presentation “Mr. Smith’s oxygen requirement is

going up. Now he’s on a facemask.”

On your signout list: “72 yo M with CHF exacerbation and COPD exacerbation…”

Hypertension Urgency/Emergency/”Malignant”

Causes of hypertension in hospitalized pts

Who needs meds? What meds?

Most common presnetations of hypertensive Emergency

Stroke: 25% Pulmonary Edema: 23% Hypertensive Encephalopathy: 16.3% CHF: 12% Some others:

• Intracranial hemorrhage• Aortic dissection• Ecclampsia• MI

Contributing factors Pain Alcohol/benzo withdrawal Cocaine/amphetamines Anxiety BP Med withdrawal White Coat Htn NSAIDs Steroids OSA Cuff Size Urinary Retention (think about in post-op)

This may even be overly aggressive

Some non IV meds (if you must)

Nitropaste (can be removed) Captopril Nifedipine Clonidine PO (rebound htn)

But really…do they need these?

Questions?