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Vital Signs and Resuscitation - part 6

Bóc tách động mạch chủ là một giọt nước mắt của động mạch chủ ngực tại vòm. Dissects máu thông qua các intima-lớp vào các phương tiện truyền thông-lớp. Các bệnh nhân điển hình là một nam giới lớn tuổi cao huyết áp với khởi phát đột ngột đau ngực nghiêm trọng của chất lượng | 82 Vital Signs and Resuscitation from confusion to lethargy. Visual changes seizures and focal neurological changes may occur. The physical exam often reveals papilledema and or retinal hemorrhages. Pressures may exceed 250 130 mmHg. Treatment nitroprusside Nipride 0.5 ug kg min IV is a fast acting arterial and venous dilator. Labetalol Normodyne in 20mg IV increments may also be used. Aortic Dissection Aortic dissection is a tear of the thoracic aorta at the arch. Blood dissects 5 through the tunica intima into the tunica media. The typical patient is an older hypertensive male with sudden onset of severe chest pain of a tearing quality radiating to the back. A proximal dissection affecting the aortic valve and heart results in the diastolic murmur of aortic insufficiency and possible pericardial effusion and tamponade. Involvement of the carotid arteries may result in signs of stroke. Paraplegia may be present if the vertebral and spinal arteries are involved. Pulse differences are aften present in the extremities. Tachycardia and signs of inadequate organ perfusion such as clammy skin and delayed capillary refill may be present. A chest x-ray often shows a widened mediastinum. Treatment a thoracic surgeon should be immediately notified. A beta-blocker such as labetalol Normodyne 20 mg IV is administered followed by nitroprusside Nipride beginning at 0.5 Jg kg min to maintain the systolic pressure at about 120 mmHg. Hypertension and Cerebrovascular Accident In hypertension accompanying a cerebrovascular accident it is sometimes difficult to determine whether hypertension is the cause or the result of the problem. Increased blood pressure is frequently a response to stroke although the patient with a thrombotic or embolic stroke usually has only a small elevation. As with an ischemic stroke hypertension may contribute to an intracerebral hemorrhage or be the result of it. Subarachnoid hemorrhage is seen in a younger population and is the result of a ruptured .