My buddy, Mike Weinstock, writes an amazing series of Emergency Medicine books called Bouncebacks. I brought Mike back to talk about a chapter from the book on a 55-year-old male who presented with hypertension. Needless to say, he bounced back. This episode has Mike walk us through the case and we discuss the various points it raises.
Michael Weinstock
Mike Weinstock is an emergency medicine physician, Director of research Adena Health System, Prof of EM adjunct at Ohio State, exec editor UC MAX podcast, lead clinical editor JUCM
Other Episodes with Mike
- EMCrit 303 – A Bounceback Case with Mike Weinstock
- EMCrit Wee – The Mock Trial Verdict and a Discussion with Mike Weinstock
The Book
The Chapter from Mike's Book: Bouncebacks! Critical Care
ACEP Clinical Policy on Asymptomatic Hypertension
Additional New Information
More on EMCrit
- EMCrit 373 – Mike Weinstock with another Critical Care Bounceback: “Asymptomatic Hypertension” - April 18, 2024
- EMCrit Wee – Ross Prager on 10 Heuristics for the New ICU Attending - April 13, 2024
- EMCrit 372 – FoundStab Intubation SOP - April 5, 2024
Why don’t you use Clevidipine?
not generic, most hospitals restrict it and discourage use unless necessary
As a prehospital nurse, I often wonder how you’d want us to treat these rse cases in a way that would get you the best start on treatment. I think we’ve all seen those status patients who don’t respond even to repeat midazolam. My state doesn’t allow the use of Keppra or pheno- drugs for ALS, so on report I would recommend ketamine, and hopefully get a sympathetic doc in a box to let me drop the tube. Is this an approach you would endorse, or might this interfere with your workflow?
Another great episode with Mike, so many pearls. repeat blood pressure would be mandatory and hard to believe the pt left without one on the initial visit. while not possible in many shops i will call/have someone call the pt’s clinic and get them a follow up appointment in the next 48 hrs or whatever timeframe is needed for the disease and when able ask the pcp if there are labs/meds/etc that they want done prior to them seeing the pt. the other thing i’ve been doing more of is having the pt’s nurse in the room documenting in their… Read more »
great comments, brother
Brian Levy, MD, FACEP I think that one of the morals of this story is, with due respect to Phillip Shayne and others who have vociferously advocated for us not to treat “asymptomatic hypertension,” that we are asking for a decade or so of misery and litigation by failing to treat pressures > 180 or so, anyway (pick your number; maybe even 160). Rosen’s and the ACEP policy is not currently serving us well. Like it or not, we live in a time where physicians will be held accountable for poor decisions on the part of patients, especially if we… Read more »