Protocol 2-528 - Hypertension

CMH EMS & MIH Protocols

EMD:

• No specific protocol.

EMR:

• Calm and reassure the patient.
• Identify possible causes.
• Consider Oxygen if SpO2 less than 88%.
• Apply Cardiac Monitor limb leads.
• Obtain and compare blood pressures in both arms.
• Dim lights. Avoid loud noises and rough transport.
• Transport with head slightly elevated.
• Epistaxis: Squeeze nose for 10-15 minutes continuously.

EMT:

• Ensure completion of applicable items above.
• Pregnant: Consider transport in left lateral recumbent position to reduce risk of Vena Cava compression.
• If destination hospital is on CT divert and patient is symptomatic: Transport to the next closest appropriate facility with a CT machine and taking into consideration the patient's wishes.

AEMT:

• Ensure completion of applicable items above.
• IV NS/LR.

RN:

• Ensure completion of all applicable items above.
• Consider IO NS/LR.
• Do not reduce MAP lower than 20% of the original.
• DBP greater than 115 with nausea, ALOC, blurred vision, headache, or chest pain: Contact MEDICAL CONTROL for:

• Adult:	Pediatric:
  Consider Labetalol 20 mg over 2 min IV/IO. Consider Hydralazine 10-20 mg IV/IO/IM. Consider Nitroglycerin 0.4 mg SL. Consider Nitroglycerin drip IV/IO.	Consider Labetalol 0.4-1 mg/kg/hr IV/IO. Click "calculate" to get dose. Consider Hydralazine 0.1-0.2 mg/kg (max 20 mg) IV/IO/IM. Click "calculate" to get dose.

• Pregnant (20-weeks gestation through 4-weeks post-partum):
• Actively seizing: Magnesium Sulfate 4 g IV/IO/IM (IV/IO in NS over 5 minutes). Refer to Protocol 2-792 - Seizure.
• Consider contacting MEDICAL CONTROL for:
• Magnesium Sulfate 4-6 g IV/IO in NS over 20 minutes or 2 g/hr.
• OR Labetalol 20 mg IV/IO over 2 mintues.
• OR Hydralazine 5-20 mg IV/IO/IM.

Medic:

• Ensure completion of all applicable items above.

CP:

• Ensure completion of all applicable items above.
• Refer to MIH Protocol 4-167 - Chronic Hypertension Management.

CMH Pre-Hospital Services Mission: "Provide safe, exceptional, and compassionate care to our communities with an emphasis on highly trained and empowered staff."

CMH Mobile Integrated Healthcare Mission: "Provide exceptional, compassionate, and patient-centered care by a mobile collaborative team to improve patient experience, improve quality outcomes, and reduce healthcare costs."

Polk, Hickory, Cedar, & St Clair County EMS Protocols is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.