blood pressure control guidelines (head bleed, dissection, AAA)

RAGING HYPOTHETICAL:

--you have a patient with a vessel somewhere that has either ruptured or is about to

--you call the appropriate surgeon, who is on the way, but in the meantime, what can you do?

MINIMIZE THE DAMAGE:

ICH:

--lowering to SBP 140-160 probably safe

--theory: less/slower hematoma growth

--options: nicardipine (less cerebral vasospasm)

AORTIC DISSECTION:

--SBP 100-120, HR <60

--theory: reduce shear forces

--options: beta blocker (labetolol push, esmolol drip), nitroprusside

RUPTURED AAA:

--goal SBP 80-100

--theory: permissive hypotension; bleed slower, less likely to blow out the few clots they're making

Reference(s): uptodate.com: Ruptured abdominal aortic aneurysm, management of aortic dissection, Spontaneous intracerebral hemorrhage: Prognosis and treatment, Kodama K, et al. Tight heart rate control reduces secondary adverse events in patients with type B acute aortic dissection, picture