Round 23 (High Blood Pressure)

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9 • 816 Ratings

🗓️ 1 July 2021

⏱️ 33 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

CAUTION: THESE NOTES CONTAIN SPOILERS!!

Case Introduction

You are working a shift at EM Clerkship General when you are handed the next chart, a 60 year old male presenting with high blood pressure.

Initial Vitals

* Temp 98.0F* HR 90* RR 18* BP 220/120* O2 98%

Critical Actions

* Perform thorough neurological exam (and find papilledema)* Diagnose Hypertensive Emergency* Start anti-hypertensive drip (usually Nicardipene)* Recheck patient’s blood pressure after intervention* Admit to ICU

Further Reading

Hypertensive Emergency (EMCrit)

Transcript

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0:00.0	Hello, residents. My name is Zach Olson. I'm joined today by Mike Estefan, and thank you for downloading this month's episode of the EM Clerkship Podcast.
0:10.0	This episode is sponsored by Pearson Rabbit's Insurance. We will talk more about Pearson Rabbit's after our case.
0:16.9	Today is round number 23 of the game, and Mike will need to perform today's case in real
0:22.5	ABEM oral boards format. He has 15 minutes to complete the case, and he has no idea what the
0:27.9	case is ahead of time. These cases were created by me. They're not derived from actual ABM cases
0:32.8	that I had, and they are not real patients. Mike, take out a piece of paper and a pencil, place the paper sideways in front of you. Put the human body on the left side of it and let me know when you are ready. Let's do this, my friend. All right, let me get my clock ready. Dr. Estefan, this will be a single patient encounter. You'll have 15 minutes to complete the case. Before we begin, do you have any questions?
0:55.0	I do not.
0:55.9	Let's do it.
0:57.4	All right, let's begin.
1:02.5	Dr. Estefan, you are working at Clerkship General Hospital,
1:04.6	and the next chart gets put in your rack.
1:06.2	Chief complaint, high blood pressure.
1:07.0	Okay.
1:08.9	I walk into the room.
1:09.6	What do I see?
1:18.1	You see an older male, adult male, um, kind of looks anxious, staring at the monitor.
1:26.4	Okay. And do we have an age on him? Um, yeah, his name is Preston Hyde and he is 60 years old.
1:27.0	Okay.
1:32.1	60 year. Um, I walk into the room. Hi, my name is Dr. Estefan. I'm one of the doctors that will be taking care of you today. What brings you to the hospital today? Hey, Dr. Estefan,
1:37.4	my blood pressure, it's critical. Okay. Tell me more. I was, what do you want to know? Look at it. Look at, what is it right now?
1:47.0	Uh, I don't know. Can we get an opening set of vitals?
1:50.0	I'm sure. His heart rate is 90. His respiratory rate is 18. His blood pressure is 220 over 120. His O2 saturation is 98%.
	...

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