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Hypertensive Emergency

A summary of the hypertensive emergency treatment guidelines from: 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines Full Text     PubMed Acute Aortic Dissection Preferred drugs: esmolol, labetalol Reduce SBP to < 120 mm HG within

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Vasopressor Dosing

Epinephrine: Alpha 1+2, Beta 1+2 receptor agonist Increases  inotropy (contraction) and chronotropy (heart rate) Infusion 0.1-1 mcg/kg/min Norepinephrine (Levophed): First line agent for septic shock Strong Alpha 1+2 agonist, mild Beta 1 agonist Minimal chronotropic effects (heart rate increase) Infusion 0.1-5 mcg/kg/min Dopamine: Alpha 1-2 effects at high doses (over 20 mcg/kg/min), Beta 1 effect and NorEpi release. Worsens tachycardia

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ACLS Summary

Cardiac Arrest:  CPR Shock VF/VT Epinephrine 1 mg q3-5min One of the following may be considered for shock refractory VF/VT: Amiodarone 300mg IV/IO bolus (1st dose), 150 mg IV/IO (2nd dose) Lidocaine 1-1.5 mg/kg IV/IO (1st dose), 0.5 – 0.75 m/kg IV/IO (2nd dose) Treat reversible causes: Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo / Hyperkalemia Hypothermia Tension pneumothorax Toxin Thrombosis

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Pericarditis

Acute Pericarditis: A summary of the 2015 European Society of Cardiology Guidelines For The Diagnosis And Management Of Pericardial Diseases ( Full Text ) Diagnosis: Two or more of the following… Chest pain consistent with pericarditis (sharp, worse with laying flat and inspiration, better sitting up),  80-90% Pericardial friction rub (high pitched, scratchy , left sternal border),  <33% Typical ECG changes ,

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Asymptomatic Hypertension

Definition of hypertension:1 Normal: 120/80 or less Pre-hypertension: 120-139/80-89 Stage 1: 140-149/90-99 Stage 2:  >160/>100 Is there evidence to suggest that immediate and rapid blood pressure reduction is beneficial in patients with hypertension and NO other symptoms ? JNC-71 “However, there is no evidence to suggest that failure to aggressively lower BP in the ER is associated with any increased

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