A Hypertensive emergency is any elevation in blood pressure in the presence of end-organ dysfunction. Aggressively treating severe asymptomatic hypertension (very high blood pressure without clear end organ damage) is not indicated, not supported by the literature and DANGEROUS. First, do no harm.
In accordance with most major guidelines it is recommended that hypertension be diagnosed when a person’s systolic blood pressure (SBP) in the office or clinic is ≥140 mm Hg and/or their diastolic blood pressure (DBP) is ≥90 mm Hg following repeated examination.
| Non-ischemic (high-flow) | Ischemic (low-flow) | |
| Physical Exam | Typically painless, not fully tumescent | Painful, fully tumescent with corpus cavernosa rigidity without involvement of corpus spongiosum and glans penis |
| Aetiology | High-flow priapism is extremely rare and most commonly associated with antecedent trauma including blunt trauma, or resulting from needle injury of the cavernosal artery. | Low-flow priapism is caused by impaired relaxation and/or paralysis of cavernosal smooth muscle and in sickle-cell disease |
| Management | NOT Emergency | Emergency |
Current criteria for the diagnosis of diabetes (2016 guidelines)
CDC Sexually Transmitted Diseases (STDs) Treatment Guidelines 2015
Latest guidelines for the management of Hypertension – JNC VIII
…for every hour you delay, the patient has a 33% increased risk of death!
Burns Rule of TENS:
1. Estimate burn size (TBSA) to the nearest 10%.
2. Multiply %TBSA x 10 = Initial fluid rate in mL/hr (for adult patients weighing 40 kg to 80 kg).
3. For every 10 kg above 80 kg add 100 mL/hr to the rate.
Contrary to common belief, The Glasgow Coma Scale (GCS) is NEVER out-of-stock and the lowest score possible is 3.
The most dangerous time to walk on Nairobi’s streets is on a Friday, around 7am, particularly along Mombasa Road.
The World Day of Remembrance for Road Traffic Victims (WDR) is commemorated on the third Sunday of November each year – to remember the many millions killed and injured on the world’s roads, together with their families, friends and many others who are also affected. It is also a Day on which we thank the emergency services and reflect on the tremendous burden and cost of this daily continuing disaster to families, communities and countries, and on ways to halt it.
There is no need to immediately reduce the BP in an asymptomatic patient with a high blood pressure…
10 Factors That Can Affect Blood Pressure Readings
The diagnosis of hypertensive emergency is made based upon the findings of hypertension in the setting of end-organ damage (usually heart, brain, or kidneys). What you really care about is the rate of increase rather than the actual BP number (there is no defining threshold).
