Cardiovascular Critical Care II

Patient Case

K.G., a 71-year-old woman with a history of atrial fibrillation, coronary artery disease status post three-vessel

coronary bypass artery grafting 6 years ago, diabetes, and osteoarthritis, is being admitted to your MICU for

temperature control after PEA arrest and subsequent ROSC. K.G., who remained comatose after the ROSC,

was intubated and is now hemodynamically stable (BP 94/72 mm Hg and HR 86 beats/minute). Which is the

most accurate statement regarding temperature control?

during hypothermia.

(Bress 2024; Johnson 2012; Marik 2007; Aggarwal 2006):

Asymptomatic, markedly elevated blood pressure: A systolic blood pressure (SBP) greater than 180 mm

Hg and/or a diastolic blood pressure (DBP) greater than 110–120 mm Hg without evidence of new or

worsening target organ damage

with new or worsening target organ dysfunction (e.g., acute kidney injury, heart failure exacerbation,

obtundation). Table 7 lists example conditions that, when accompanied by high BP, define hypertensive

emergency

Importantly, target organ damage may still occur below SBP and DBP thresholds used in definitions.

MAP: Average pressure in the arteries (mm Hg) experienced during one cardiac cycle. Calculated by

MAP = 1/3 SBP + 2/3 DBP.

Eclampsia, preeclampsia

Hypertensive encephalopathy

Acute kidney injury

Acute shortness of breath, flash pulmonary edema, or acute left

ventricular dysfunction

Acute aortic dissection (type A or B)

Acute intracranial bleeding (nontraumatic)

Seizures

Acute myocardial ischemia/infarction

Retinopathy

Cerebral infarction

Intoxications – Cocaine, amphetamines, phencyclidine hydrochloride, stimulant diet pills