Acute Severe Hypertension - part 4

Hospital and Internal Medicine Podcast

Gil Porat, M.D., FACP, CPT

Health & Fitness:medicine, Medicine, Fitness, Science, Health & Fitness

4.8 • 587 Ratings

🗓️ 25 April 2020

⏱️ 18 minutes

🔗️ Recording | iTunes | RSS

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Summary

Did you know systolic and diastolic blood pressure are NOT measured by automated BP cuffs? PRES (Posterior Reversible Encephalopathy Syndrome), also known as RPLS (Reversible Posterior Leukoencephalopathy Syndrome), is something you should recognize when you see it. Brief mentions of esmolol, nitroprusside, and other topics are scattered somewhere in between musings.

Transcript

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0:00.0	Hypertension and particularly acute severe hypertension is just a small subsection of vascular medicine.
0:09.0	And here we are at lecture number four on that topic and you see that not everybody appreciates the
0:15.0	vascular system in their day-to-day lives. For example, it has been shown and not everybody appreciates this that if you took
0:23.6	all the arteries out of your body and laid them on the ground beside you in a straight line,
0:28.6	you'd be dead. While you probably would have figured that fact out on your own, here's a fact
0:34.6	that you may not appreciate that most people in medicine don't think about day-to-day.
0:39.9	And that's the topic of automatic blood pressure cuffs. So of course when you were taught how to
0:44.9	perform a manual blood pressure, you listen for those sounds, for when we could discern the
0:50.9	systolic and diastolic blood pressures based on auscultation.
0:55.5	But think about it, automated cuffs, which is how most blood pressures are taken in most
1:01.3	hospitals and most settings, don't auscultate, meaning the cuff can't hear.
1:07.4	And since these non-invasive cuffs can't hear, what they're doing is they are feeling, they are
1:12.8	feeling for oscillations and pulsations, and they're not listening. And therefore, the only thing
1:20.2	these automated cuffs are measuring are the map, the mean arterial pressure. And so these
1:27.0	manufacturers of these non-invasive blood pressure
1:30.3	cuffs then use algorithms that are designed by each individual manufacturer to come up with a
1:38.2	calculation to give a systolic and a diastolic pressure. So how trustworthy is automated non-invasive blood pressure
1:47.0	monitoring? Well, that's actually the title of an article from ACP Hospitals all the way back from
1:52.3	October of 2009. That's the exact title. How trustworthy is automated non-invasive blood pressure
1:58.2	monitoring. And the article explains that since each manufacturer has its
2:03.3	own method, its own algorithms, its own calculations, there can be considerable variation between
2:11.9	machines and manufacturers. And that's why what matters most, particularly in pretty critical or important situations,
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