General Approach to All Patients

Hypertensive Emergencies

A Hypertensive Emergency can be defined as systolic BP > 220 mm Hg and/or Diastolic BP > 120 mm Hg. Prehospital treatment of isolated hypertension may result in critical reductions in target organ perfusion due to uncontrolled lowering of blood pressure. Focus on addressing the manifestations of hypertensive emergencies, such as chest pain or heart failure.

Basic Life Support

  • Supplemental oxygen

Advanced Life Support

  • Full ALS Assessment and Treatment

Chest Pain Present

  • Aspirin 324 mg PO, chewed if patient is able to swallow
    • Aspirin is contraindicated if allergic
  • Nitroglycerin 0.4 mg spray SL, every 5 minutes as needed for chest pain
    • Contraindicated if use of a Phosphodiesterase-5 (PDE5) inhibitor within last 24 hours (Viagra or Levitra); 48 hours for Cialis
    • Be prepared to administer IV NS boluses at 250 ml if hypotension develops
  • Fentanyl (Sublimaze) 1 mcg/kg (maximum 50 mcg) slow IV; repeat once after 5 minutes as needed (maximum 100 mcg total dose) if no chest pain relief after 3rd Nitroglycerin dose

No Chest Pain Present

  • Provide supportive care only
  • For patients with altered mental status, signs of stroke or pulmonary edema refer to the specific protocol