Hydralazine

We used it a lot more until the shortage began last year.

We use it in our ER but the docs seem to favor Labetolol first (and that rarely works, even after repeated doses). I love Hyrdralazine.

we to tend get orders for labetalol.but i have also given hydralazine as well .depends on doc and pt.

You might find that in the ED, a systolic of 180-190 isn't necessarily treated unless the patient is also exhibiting focal neurological deficits.

Stargazer makes a good point - the ED setting is more tolerant of a high SBP than an inpatient environment, as long as there is no head bleed, headache, visual disturbances, or neuro deficits.

I never used Hydralazine until I came to the ED where I work now. There are different protocols/physician preferences everywhere you work.

I only threw that in there because it occurred to me that if I asked for hydralazine for a blood pressure in that range (again, in the absence of any neuro sx), I'd probably get some funny looks, especially if the reading was from an automated cuff and not confirmed manually.

Yeah, and SBP 180-190 isn't really alarming unless certain signs and symptoms. We rarely treat it. Just like a blood sugar of same range.

We tend to use labetalol almost all the time, and I've given hydralazine only a handful of times in my ED.

I agree, a BP of 180-190 is definitely managed different than on the floor. However, we have to get it down otherwise the floor will straight up refuse to accept the patient until we get the SBP down.

We use hydralazine quite a bit in the ER I work in. Labetalol is an ok choice...I tend to think metoprolol works better...but if their HR is in the 30's, I doubt I would choose a beta blocker. If you're going to treat an asymptomatic pressure, however I agree with previous posts, that you're not going to treat an asymptomatic pt with a systolic of 180-190, but if you choose to, why not ask for clonidine? Its PO and works fast and well. There is a chance it can decrease their HR a little but usually not by much. (Nitropaste is also a choice but again, careful with the HR) And don't you always love those certain floors who refuse to accept until the ER completes all their demanded tasks? Some floors are ridiculous! (know that was off original topic....but same story no matter where you work seems like!)

I agree, a BP of 180-190 is definitely managed different than on the floor. However, we have to get it down otherwise the floor will straight up refuse to accept the patient until we get the SBP down.

Really? What is their rationale for this policy? It seems like it would unneccessarily delay the transfer of patients, keeping them in the ED longer than they need to be.

Yeah, I'll try not to go on a soapbox rant. This is one reason I transferred from SDU to the ER. The idiocy I observed baffled me. I once saw a charge nurse refuse a pt that had a CVA because the BP was 170's and she wanted them to lower it. They tried to explain to her that she's post CVA, that you want the SBP elevated, etc. Finally, it took the night doc coming up and explaining a simple rationale to her for her to accept the pt.

Usually our ICU and CCU won't throw a wrench, they'll take the pt. But those pts are usually the symptomatic ones and we're treating anyway. The other floors don't have a policy, they simply think that a pt with a SBP in the 180's isn't stable and they can't handle it. They essentially think we don't want to deal with the pt any longer and are just tossing it on to them.

I agree fully, it delays transfer for no apparent reason and just jams up the ER. There's been attempts to get the problem fixed, but it's just one thing after another. You know, floor vs ER.

Thanks for taking the time to explain that. It certainly sounds very frustrating.