BP: how high is too high (at 2am)? i.e., when will Pt stroke out? - page 2

by allthesmallthings 5,452 Views | 12 Comments

There was an elderly Pt running 190's/90's (manual BP), pulse WNL (SR c some PVC's), asymptomatic, no acute distress, neurologic check fine, at 2am. I called the MD about the BP, and he was a little perturbed, asking if this was... Read More


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    I'll be the odd duck and risk the flames by saying I honestly don't know whether I would have called the MD. If the patient has had a BP in that range, and even higher than that, previous to this particular set of VS....I might not have (and I say might because I wasn't there and in that situation, so I can't say for sure). If the MD has been aware of the pt's trend in BP up to this point, it maybe could have waited until the morning (I would have done more frequent checks after that, if I didn't call initially). It also would depend on the specific doc I would have been calling...you get a feel for who would want to know at that time, and who would have wanted to know in the morning (again, since the pt's trend hadn't changed). I have dealt with numerous patients over the years who ran quite high numbers, ones that I would have considered alarming, where the response was "we're watching it, it's ok." Guess that's why I'm not the doctor.

    There is no specific, magic number that would equal the patient having a stroke. If they normally run quite high, you'd be surprised.

    As for the comments re: uncontrolled pain or DT's. The pain question can be pretty simple...if the patient can tell you, how do they feel? If the patient is non-verbal or unresponsive (and this is not new, of course), are there ANY other signs of uncontrolled pain? When the cues are reflexive (facial grimacing, etc), they would generally be there. For DT's, there are a myriad of symptoms that indicate DT's, and BP alone would not be indicative. If the BP is elevated, giving them a higher score, if everything else is zero, it's not enough to suggest it. That WOULD put me on alert to make sure I'm watching for other symptoms of it, though (HR, agitation, sweating, fever, etc etc).

    Do I think it's wrong that you called? No. If you're concerned, by all means, call! The doc will get over it; you didn't call to *bother* them, you called out of concern for the patient. I just wanted to offer another perspective.
    catlvr, wooh, and caliotter3 like this.
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    I'd have called for BP meds/Ativan to ward off DTs, and that's how I would have phrased it. What most of our docs look for is change -- if a person's been 160/94 for 3 days and hops to 170/100, and they're figitty or something, I'm not going to freak. If they've been 140/90 and then they're 210/90, I'm on the phone -- same if goes the other way. I also look at HR -- You get someone who's BP drops down in 80's SBP(unless they're on beta blockers) and the HR doesn't change, that can be a sign of a major hissy about to occur in that mean old widowmaker. I've had pt's with phenochromocytoma (that's probably spelled wrong) that live with a BP of 210/110, and you have to watch it like a hawk because if you get it to drop, they go into cerebral edema and then you got a whole new set of problems....
    wooh likes this.
  3. 0
    Like everything else, it's relative. I agree with pretty much all the other good thoughts. And if it makes you feel better, I'd have also called, and I'm VERY conservative in my calls at night. (Not because I'm afraid to call the doctor, but because I don't think all that many things warrant a call in the middle of the night.) She was trending up, and this was a middle of the night, supposedly at a "relaxed/sleeping" time, so it concerns me more than a BP above their trend mid-afternoon. Throw in risk of DTs, I'd call.


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