Criteria for Giving IV BP Meds?

Anna Flaxis, BSN, RN · Oct 12, 2011

So last night at work I was getting report on a pt from the ER and noticed their blood pressure was 200/100 when triaged. 6 hrs later when I was getting report on the floor the BP was 210/110 When I asked the nurse what she had given the pt to treat the BP her excuse was nothing, as due to the pt's vomiting the pt couldn't keep any PO meds down. I questioned why Hydralizine IV hadn't been given, the nurse seemed to not understand why you would give it if the systolic is less than 220. Pt ended up getting nothing for BP in the ER. The nurse taking care of the pt is a travel nurse new to my facility, so I'm curious, what is the criteria at other facilities are for giving IV BP meds?

Generally, you're not going to see ED physicians treating asymptomatic high blood pressure in the absence of focal neurologic symptoms or cardiac ischemia. From the sounds of it, hypertension was not your patient's chief complaint; nausea and vomiting was.

Now, that doesn't mean that incidental findings aren't addressed when appropriate. Clearly your patient had acute on chronic renal failure and needed admission to the hospital to receive appropriate treatment.

The goal should have been to resolve the nausea and vomiting so that the patient could take PO meds. PO is the preferred route for antihypertensives. In my ED, we start with Zofran, then Compazine, then switch to something like Ativan if those are ineffective.

It would be a whole different story if the patient presented with elevated blood pressure and neurological or cardiac symptoms. The ED and the floor are two different animals.