A discussion of the etiologies, evaluation, and management of acute hypertension that develops in a patient already hospitalized. #InternCrashCourse #FOAMed #MedEd
I tried to get DALLE-E 2 to create a picture of a resident in scrubs and a fleece vest for the video, but despite using up all my free attempts this month for it, it didn't understand "vest" or "fleece" in the context of a doctor. That's why this video doesn't have a picture of a doc like the others in the series. ¯\_(ツ)_/¯
Thank you. See this a lot as an acp working AIM. Probably would have added endocrine as another cause category to cover things like pheo and conns. Element of bias though as currently waiting adrenalectomy for conns myself!!
You're doing a great job with these videos doc, helping students and MD's. Doctor, what do you think about the new guidelines that consider the numbers 130/80 to be first stage hypertension? Do you agree with that and do you think those numbers should be lowered in healthy individuals? Also, what do you think is the best medicine to give on an hypertensive emrgency caused by severe anxiety?
I don't have a particularly strong opinion on redefining hypertension as >=130/80 (as recommended by the ACC/AHA in 2017), though my understanding is that it was largely based on the results of the SPRINT trial, which IMHO was significantly methodologically flawed. Interestingly, the influential American Academy of Family Physicians did not change their own recommendations on hypertension in 2017 - partially for the same reasons that I'm skeptical of it. In addition, guidelines and individual clinicians alike don't necessary make a distinction between a BP high enough to label "hypertension", a BP high enough to prescribe an anti-hypertensive med, and the BP goal for a patient on anti-hypertensives. Those three numbers are not necessarily the same. Also, BP goals should be individualized, and no one should be too dogmatic about something which is an ever-changing *guideline* rather than a rule that must be followed. The best medication to give to patient during a hypertensive emergency caused by severe anxiety is probably a benzodiazepine - in most cases.
Thank you Dr. Strong for the extremely valuable educational resource. Just a question... how do you lower BP of a specific percentage? In other words, once you choose the drug, how do you choose the dose to aim for a 20% reduction in 1h?
It's 1/3 personal experience, 1/3 advice from more experienced colleagues, and 1/3 guess. And remember, you can always give more anti-hypertensive, but you can't take it back once given. (i.e. err on the side of underdosing the patient but with frequent reassessment)
thanks for the review. i have been on either side of the bed on this, having had HTN since I was 8, & as an emergency nurse, realizing this is scary. Working as part of a team diagnosing // treating the underlying cause can be challenging, being far more than administering sublingual nitroglycerin, iv lasix, or iv labetalol.
This is such a valuable topic, and yes hydralazine is evil, especially if continued on the outpatient basis. So many of my patients get switched from their regular antihypertensives to hydralazine in the hospital. They are discharged on TID hydralazine and I have to deal with it....
You’re also limited by what can be given on the floor at a given hospital. My hospital has no problem with IV hydralazine but anything like labetalol or iv nitro they’ll need to be in ICU.
At a previous hospital where I worked, IV beta blockers could be given on the floor but only if a doctor was physically present at the bedside when they went in. For every single dose. But as soon as the med was in the vein, the doc could leave (i.e. even before onset of action). Such a dumb policy!
Thank you for another great video again🔥 Doc there is something I would like to ask : Do you know any resources ( textbook , websites ) that describe in details the exact practical informations and steps in our practice in internal medicine and emergency medicine because for example when I studied shock in a high-rated and well recognized book for emergency medicine it did not mention practical points like shock index or fluid calculation by using shock percent until I found these informations accidentally on internet websites. So please if you can recommend any resources that would provide sufficient practical knowledge I would be thankful .
I definitely don't know of any textbooks. For other resources, I don't know if this is precisely what you mean, but I think the Rational Clinical Exam series in JAMA and Things We Do For No Reason in the Journal of Hospital Medicine are both great - though the latter is more of the opposite of what you are asking for (i.e. practical things that we do, but which he shouldn't!)
The Patagonia fleece comment killed me haha. Too real.
Your best series yet!
I tried to get DALLE-E 2 to create a picture of a resident in scrubs and a fleece vest for the video, but despite using up all my free attempts this month for it, it didn't understand "vest" or "fleece" in the context of a doctor. That's why this video doesn't have a picture of a doc like the others in the series. ¯\_(ツ)_/¯
Why so underrated ???? This is just what we need. Nobody ever explained like this dif diagnosis ❤ more videos please
It's very esoteric content
I became addicted to this type of series.
I cannot miss any episode ❤
Exceptional series!!!! Don’t stop haha 🎉
Absolutely loving the rapid response series!!
as a rapid response nurse, this is great content!
Thank you. See this a lot as an acp working AIM. Probably would have added endocrine as another cause category to cover things like pheo and conns. Element of bias though as currently waiting adrenalectomy for conns myself!!
This is simply the best unmatched world over am from Zambia and I watch him always
A great video elaboration of the “no evidence just stop!” article written in Today’s hospitalist some time back
Beautiful lecture lot of love from India
You are awesome❤
Thank you
Learned a lot🎉
You're doing a great job with these videos doc, helping students and MD's.
Doctor, what do you think about the new guidelines that consider the numbers 130/80 to be first stage hypertension? Do you agree with that and do you think those numbers should be lowered in healthy individuals?
Also, what do you think is the best medicine to give on an hypertensive emrgency caused by severe anxiety?
I don't have a particularly strong opinion on redefining hypertension as >=130/80 (as recommended by the ACC/AHA in 2017), though my understanding is that it was largely based on the results of the SPRINT trial, which IMHO was significantly methodologically flawed. Interestingly, the influential American Academy of Family Physicians did not change their own recommendations on hypertension in 2017 - partially for the same reasons that I'm skeptical of it. In addition, guidelines and individual clinicians alike don't necessary make a distinction between a BP high enough to label "hypertension", a BP high enough to prescribe an anti-hypertensive med, and the BP goal for a patient on anti-hypertensives. Those three numbers are not necessarily the same. Also, BP goals should be individualized, and no one should be too dogmatic about something which is an ever-changing *guideline* rather than a rule that must be followed.
The best medication to give to patient during a hypertensive emergency caused by severe anxiety is probably a benzodiazepine - in most cases.
Are there any lectures notes on the “How to approach different symptoms “ series
❤❤❤
Thank you Dr. Strong for the extremely valuable educational resource. Just a question... how do you lower BP of a specific percentage? In other words, once you choose the drug, how do you choose the dose to aim for a 20% reduction in 1h?
It's 1/3 personal experience, 1/3 advice from more experienced colleagues, and 1/3 guess. And remember, you can always give more anti-hypertensive, but you can't take it back once given. (i.e. err on the side of underdosing the patient but with frequent reassessment)
@@StrongMed Thank you very much
thanks for the review. i have been on either side of the bed on this, having had HTN since I was 8, & as an emergency nurse, realizing this is scary. Working as part of a team diagnosing // treating the underlying cause can be challenging, being far more than administering sublingual nitroglycerin, iv lasix, or iv labetalol.
This is such a valuable topic, and yes hydralazine is evil, especially if continued on the outpatient basis. So many of my patients get switched from their regular antihypertensives to hydralazine in the hospital. They are discharged on TID hydralazine and I have to deal with it....
This is the worst!
I love hydralazine
You’re also limited by what can be given on the floor at a given hospital. My hospital has no problem with IV hydralazine but anything like labetalol or iv nitro they’ll need to be in ICU.
At a previous hospital where I worked, IV beta blockers could be given on the floor but only if a doctor was physically present at the bedside when they went in. For every single dose. But as soon as the med was in the vein, the doc could leave (i.e. even before onset of action). Such a dumb policy!
Thank you for another great video again🔥
Doc there is something I would like to ask : Do you know any resources ( textbook , websites ) that describe in details the exact practical informations and steps in our practice in internal medicine and emergency medicine because for example when I studied shock in a high-rated and well recognized book for emergency medicine it did not mention practical points like shock index or fluid calculation by using shock percent until I found these informations accidentally on internet websites.
So please if you can recommend any resources that would provide sufficient practical knowledge I would be thankful .
I definitely don't know of any textbooks. For other resources, I don't know if this is precisely what you mean, but I think the Rational Clinical Exam series in JAMA and Things We Do For No Reason in the Journal of Hospital Medicine are both great - though the latter is more of the opposite of what you are asking for (i.e. practical things that we do, but which he shouldn't!)
Ok. I will check them
Thank you doctor