Hypertensive crisis is a condition in which there is a sharp increase in blood pressure, accompanied by a deterioration in well-being. Hypertension is very common, so almost everyone has encountered crisis manifestations in relatives, friends or colleagues. This means that any person must be able to recognize this condition and provide competent emergency care..
Hypertensive crisis, causes, symptoms, first aid for hypertensive crisis.
As a rule, hypertensive crisis occurs in people who have long suffered from hypertension, who are aware of their disease; and therefore they themselves are able to determine the nature of the poor health that occurs in such a state. However, sometimes a hypertensive crisis also occurs in a person who usually has normal arterial pressure. This is possible, for example, with excessive consumption of drinks of energy drinks containing caffeine, or with the use of certain narcotic drugs – cocaine and similar substances.
pressure may be different. Someone does not feel its rise at all, and someone even tolerates a slight excess of the usual norm very painfully. Symptoms of a hypertensive crisis are found in different people in various combinations. Their common feature can be considered that they arise suddenly. In most cases, a person is able to say up to an hour when he started a hypertensive crisis.
The most common possible symptom is a headache. It arises from the fact that an increase in blood pressure in the vascular bed leads to an increase in intracranial pressure. As a rule, the back of the head hurts; this sensation may be constant in pressure or be pulsating. Redness of the face and neck is also often noted when the patient complains of a feeling of heat. Visual disturbances can occur – its weakening, flickering of small black dots or a veil before the eyes.
Due to the spasm of the blood vessels, the heart muscle has to exert more power to pump blood. There is a feeling of increased, rapid heartbeat. Sometimes there are a variety of unpleasant sensations in the region of the heart – from discomfort to pain attacks, if the patient suffers from angina pectoris. Dizziness, nausea, vomiting are possible.
In some patients, the so-called autonomic symptoms come to the fore – signs associated with disorders of the autonomic nervous system. If they prevail over other symptoms, it is sometimes difficult at first glance to suggest a hypertensive crisis. Vegetative manifestations include trembling in the body, excessive sweating, cooling of the hands and feet, a feeling of lack of air.
Hypertensive crisis is able to proceed in different ways. The most common option is with a sharp onset, when a headache suddenly occurs, the patient becomes restless, excited, complains of nausea, a feeling of heat, seeks help. As a rule, such crises are rather short-lived, lasting up to 5-7 hours. After normalizing the pressure, the patient may experience frequent urination. In the future, health is getting better.
A rarer, but more dangerous version of the hypertensive crisis is called edematous. Symptoms are dominated by signs of cerebral edema. It begins more gradually. Such patients, in contrast to patients of the first group, usually become silent, reserved, answer questions with a delay. Complain of severe headache, visual disturbances. Sometimes consciousness becomes oppressed. If assistance is not provided on time, the patient’s condition sometimes lasts up to several days.
The third, most rare, but most dangerous variant of a hypertensive crisis is a convulsive one. What causes convulsions, disorders of consciousness and speech. This kind of hypertensive crisis requires immediate medical attention..
A sharp increase in blood pressure, especially if it happened in a person with already existing diseases of the circulatory system (angina pectoris, myocardial infarction and strokes), leads to pathological changes in the myocardium, kidneys and other organs, that is, it can aggravate the course of the disease. Therefore, for any hypertensive crisis, you should seek qualified medical help.
First aid for hypertensive crisis, pressure measurement.
The first skill that a person who needs to help a patient with a hypertensive crisis should have this, is the measurement of blood pressure. It is this manipulation that is primarily necessary in cases of suspected hypertensive crisis. Otherwise, focusing only on the symptoms, you can misinterpret them, which will lead to errors in the provision of emergency care..
Indeed, if, for example, facial redness or visual impairment is caused by a stroke, and not by a hypertensive crisis, then the use of drugs that lower blood pressure can lead to arterial hypotension, which will reduce the flow of blood to the brain and make the situation even more serious for the patient.
Blood pressure can be measured by any available serviceable device – mechanical, semi-automatic or automatic. However, in each case, the measurement must be repeated three times so that the blood pressure value is determined more accurately. It is very important. With a single measurement, the result may turn out to be incorrect, firstly, due to some external factors (noise), and secondly, due to the so-called “white coat” syndrome (increased reaction to medical staff or anyone providing assistance).
A person, when he feels bad and fears for his health, is especially anxious and susceptible. All this is accompanied by stress and experiences in which blood pressure rises even more. Therefore, the first measurement of blood pressure, especially if this procedure is little familiar to the patient, often gives high figures. This creates the need for three repetitions of the measurement. The patient gradually calms down, and the third time the results are most accurate. The tonometry technique is described in detail in the chapter on medical manipulations..
In crises, blood pressure rarely returns to normal on its own. Special medications are required, however, along with their administration, it is necessary to provide the patient with non-medical assistance. It is necessary to provide physical and emotional peace, to plant, and it is better to lay down and try to calm a person, as the increase in blood pressure is sometimes accompanied by a feeling of anxiety, irritability or tearfulness.
It is advisable to provide assistance in a well-ventilated, quiet room, as lack of oxygen, pungent odors and noise can only help maintain high blood pressure values. Bright lighting should also be avoided, especially if fluorescent lamps create it – they blink, which creates an extra strain on the eyes and impairs well-being.
In hypertensive crisis due to accelerated blood flow, patients often complain of a feeling of heat. You should advise a person to unfasten the top buttons of a shirt and offer him a cold compress. It is placed on the forehead and changed as the tissue warms up, that is, every 2-3 minutes. You can also simply wipe the patient’s face and neck with a damp cloth. If a person feels so bad that he is not able to unbutton his shirt or apply a compress, this should be done for him..
With hypertensive crises, some are worried about nausea, less often – vomiting. If the patient makes such complaints, you need to be ready to help and with vomiting – lay him on his side, prepare a basin, water for rinsing the mouth and a clean towel. As already mentioned, hypertensive crisis usually occurs in people who have been sick for a long time and are likely to receive treatment, which means that they can be helped by having access to their personal first-aid kit.
Fortunately, there are a lot of drugs that lower blood pressure, they are readily available and are available in almost every apartment, even if there are no hypertensive patients among its inhabitants. If a person has a hypertensive crisis on the street, any pharmacy also has a large number of such drugs. When providing a person with a hypertensive crisis, there are two basic rules to remember..
First, no matter what medicine is used, it must be borne in mind that they all do not act instantly. The effect occurs 15–40 minutes after taking the pill, and in the future, as the drug is absorbed, its effect is enhanced. As a rule, the maximum effect can be observed 2-3 hours after administration. With this in mind, you should not measure blood pressure almost immediately after the patient drank the pill.
After such a short period of time, there will be no effect, and excessive rush can lead to errors in actions. An early measurement of blood pressure gives the impression that the drug does not work; as a result, the patient receives another dose or more or a completely different drug. As a result, all these funds, starting to act on time, not only cause a sharp drop in blood pressure, but can also introduce the patient to another extreme – hypotension.
Sudden changes in blood pressure, the transition from hypertonic to hypotonic state create an enormous load on the heart, brain, blood vessels and kidneys. As a result, one can expect a deterioration in well-being and manifestations of complications. To avoid such consequences, you need to evaluate blood pressure no more than every 15 minutes.
The second rule is to correctly calculate the rate of drop in blood pressure. Seeing how the tonometer needle begins to oscillate at the numbers 160, 180 or 200 mmHg. Art. (these are, as you know, very high numbers), the person who is helping, if he is not a doctor, involuntarily panics. Naturally, there is a desire to bring the patient to the figures of blood pressure of 120-130 mm Hg as soon as possible. Art. This is not worth doing.
In uncomplicated hypertensive crises (if there is no pain in the heart, impaired limb movements, signs of pulmonary edema), the rate of decrease in blood pressure should be 15–20 mm Hg. Art. in hour. The international recommendations for the treatment of hypertensive crises even suggest schemes with which the patient is returned to the usual figures of blood pressure within 2-3 days. Therefore, one should not overload a person with medicines. If during emergency care there is at least a tendency to lower blood pressure, it’s already good.
Before giving a person some kind of drug, you need to find out what blood pressure values the patient has at normal times. Strive to reduce blood pressure to numbers less than usual should not. For most elderly people suffering from angina pectoris and arterial hypertension, “comfortable” blood pressure is 140 and 90 mm Hg. Art. It can be regarded as high for a young healthy person, however, for such a patient, these numbers will be the norm.
To combat hypertensive crises, there are special treatment regimens. Employees of the ambulance team and doctors in hospitals usually use several drugs at once, which are administered in a certain sequence. When providing first aid, it is not necessary to adhere to these schemes, especially since for most of them intravenous administration of drugs is necessary. You only need to be able to find the right medications, know how to use them, and have an idea of contraindications to them.
Previously used for hypertensive crises almost always. It is recommended to chew or take inside, washed down with water, in an initial dose of 10 mg (1 tablet). With a weak effect, re-use of the drug is allowed after 20-30 minutes. Despite the fact that nifedipine quickly and effectively reduces blood pressure, it is worth remembering contraindications. It can not be taken by people with serious heart diseases (recent myocardial infarction, severe angina pectoris). In addition, if the patient has signs of angina pectoris, myocardial infarction or pulmonary edema at the time of crisis (chest pain, shortness of breath), nifedipine is also strictly contraindicated.
Also applies to quick-acting drugs. It is taken in a dosage of 25-50 mg under the tongue. The drug has a minimum of contraindications, is well tolerated and effectively reduces blood pressure. When taking captopril, you need to carefully monitor the dynamics of changes in blood pressure, as it may drop too sharply.
Anaprilin (20–40 mg), metoprolol (25–50 mg) and carvedilol (12.5–25 mg).
They belong to the same group of drugs and have a similar effect. They lower blood pressure and slow down the pulse. In this connection, medicines are contraindicated in patients with an initial pulse value of less than 60–65 beats per minute. Before offering any of these drugs to a patient, one must also clarify whether he has cardiac conduction disorders (blockade) and lung diseases (for example, bronchial asthma). Under these conditions, they cannot be used..
Known as a medicine intended for the treatment of angina attacks. But, in addition to acting on the vessels of the heart, this drug also affects other parts of the vascular bed. The expansion of arteries and veins leads to a decrease in blood pressure, which can also be used for hypertensive crisis. Nitroglycerin is especially indicated for those with chest pains amid increased blood pressure. When using nitroglycerin (it can be not only in tablets that are taken under the tongue, but also in the form of a spray), you should be aware of possible side effects, the most common of which is headache.
Many older people suffering from arterial hypertension are well aware of the old remedy – intramuscular injection of solutions of papaverine hydrochloride and dibazole. Now this combination of drugs is considered not quite effective, but in the absence of funds, you can use it. The remaining drugs that can be used to combat hypertensive crisis are intended for intravenous administration, which creates inconvenience in their use (enalaprilat, magnesium sulfate, etc.). They are mainly practiced by ambulance staff and in hospitals..
Sometimes, furosemide in tablets or solutions for intramuscular administration (20–40 mg) is used to normalize blood pressure in conditions of first aid. It quickly removes fluid from the body, which leads to a decrease in blood pressure. However, this drug can have many side effects, so it is better for him to prefer other drugs from those described above..
Hypertensive crisis can happen not only at home or at work, where medications are always available, but also in the country or in the country. In this case, it is necessary to take measures to transport the patient to the clinic, where he will be able to provide qualified medical care. In the framework of pre-medical measures, the greatest attention should be paid to non-drug methods, which have already been described above..
Even in the country first-aid kit you can almost always find antispasmodics – papaverine hydrochloride, drotaverine hydrochloride, etc. They should also be offered to a patient with a hypertensive crisis in the absence of other drugs. They have a vasodilating effect and are able to slightly improve well-being. There is a group of patients in whom hypertensive crises occur quite often and who struggle with them on their own.
But if after taking certain medications the condition has improved and blood pressure has decreased, this is not a reason to forget about the disease and continue to live on. It is necessary to consult a local doctor who will prescribe an examination and adjust the treatment of arterial hypertension, or prescribe it if before that the patient has not regularly taken any of the medicines.
The most competent behavior in the conditions of a developed hypertensive crisis is to call an ambulance team or go to the hospital admission department, and at the pre-medical stage take medications that lower blood pressure. Sometimes hypertensive crises are so serious that they entail complications – myocardial infarction, stroke, pulmonary edema, renal failure, bleeding. This is due to severe organ damage that is caused by high blood pressure..
A special approach requires a hypertensive crisis in pregnant women. Pregnancy complications associated with a sharp increase in blood pressure, such as eclampsia and preeclampsia, threatening the life of the fetus and the health of the mother. If a pregnant woman has an increase in blood pressure, she should be immediately hospitalized in a hospital. Self-medication is prohibited, as they may have a harmful effect on the fetus..
Based on the book “Quick help in emergency situations”.