Hypertension Post AAA Repair
OVERVIEW
- common
- potential life threatening -> myocardial ischaemia, anastomotic rupture, CVA
- requires urgent management and cause identification
CAUSES
- equipment/measurement error: check arterial line trace, transducer, NIBP
- wound pain: analgesia
- full bladder: make sure catheter draining
- inadequate sedation: sedate
- incomplete neuromuscular reversal: TOF assessment + sedation
- hypothermia/shivering: measure core temperature and warm
- hypoxia: treat cause and give O2
- hypercarbia: treat cause and increase ventilation
- withheld anti-hypertensives
- surgical problem: anastomotic occlusion, renal artery occlusion -> examine pulses and contact surgeon
MANAGEMENT
Resuscitation
A – assess for patency and position
B – give FiO2 1.0, check ABG
C – check pulses and BP manually, check accuracy of arterial line measurement
D – ensure patient adequately sedation and analgesia -> use propofol and fast acting opioid
Acid-base and Electrolytes
- review ABG to check metabolic status
Specific Therapy
- be aware that patient may be very sensitive to medications and become profoundly hypotensive
- esmolol: 10mg bolus
- GTN: 20-50mcg bolus -> infusion
- SNP infusion
Underlying cause
- find cause and treat appropriately
References and Links
- Wiesbauer F. Hypertension. Medmastery
LITFL
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC