Cardiovascular Critical Care II
| (c) | In the intracerebral hemorrhage population, decreased BPV has been correlated with |
|---|
improved early neurological function (Eur J Neurol 2013;20:1277-83), favorable outcome
2014;13:364β73).
| (d) | Agent selection can influence BPV. |
|---|---|
| (1) | Compared with labetalol, nicardipine has demonstrated superior results regarding |
BPV (Neurocrit Care 2013;19:41-47; Neurocrit Care 2008;9:167-176), but impact on
clinical outcomes has not been demonstrated.
| (2) | In the cardiac surgery population, clevidipine demonstrated better perioperative |
|---|
BPV compared with nitroglycerin or sodium nitroprusside but not compared with
nicardipine (Anesth Analg 2008;107:1110-1121) and was associated with decreased
time to extubation and postoperative length-of-stay (J Cardiothorac Vasc Anesth
2014;28:579-85).
| (e) | Unclear what the future clinical impact will be on other populations, how agent selection |
|---|
will influence BPV, but should be an area of future research.
| d. | All intravenous medications should be transitioned to oral medications as soon as possible. |
|---|
Oral antihypertensives should be initiated within 24 hours.
ii.
Medication history and reconciliation can assist in resuming home regimens.
iii.
Additional or new agents should be selected according to disease-specific indications.
Patient Case
B.B. is a 44-year-old man with no significant medical history who presents to the ED with a ripping sensa-
tion in his chest. His social history includes cigarette smoking, 1.5 packs/day for the past 20 years. Chest
radiography in the ED reveals mediastinal widening. Cardiac enzymes are within normal limits. Laboratory
values include sodium 135 mEq/L, potassium 4.3 mEq/L, HCO3- 24 mEq/L, SCr 0.55 mg/dL, glucose 110
mg/dL, DBil 0.2 mg/dL, and AST 39 U/L. B.B. is rushed for a chest CT and angiography, which reveal an
acute type A and B aortic dissection. His vital signs include BP 208/140 mm Hg and HR 120 beats/minute.
Which is the most appropriate management for B.B.?
24 hours.
beats/minute as soon as possible.