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Tuesday, February 19, 2013
EMERGENCY CASE OF THE WEEK
DEPARTMENT OF CARDIOVASCULAR MEDICINE
A CASE OF MALIGNANT HYPERTENSION
(Updated 19.2.2013)
Patient Name: ****** Gupta aged: 33 years, Female
Diagnosis: Malignant Hypertension
Emergency Crisis: High Blood Pressure
Patient reported to our Cardiology OPD on 24.6.2011 (1.30 PM) in a
quiet uneasy condition with her work colleague (Bank) and while
entering the clinic, near reception, she vomited and fell while her
colleague was getting the registration slip for the patient.
On Emergency call, patient was made lie down on chair and was managed as per the presentation.
Case Presentation
Patient while entering the reception, suddenly vomited and fell on side without any known cause or complaint. The accompanying office colleague could interpret only that she complained of severe headache since morning and just 10 minutes back, she started complaining of nausea and was brought to us.
No symptoms (except headache), no past history and no drug history could be collected as patient was lying in painful condition and was unable to tell her symptoms.
Observation & Quick Clinical Examination was the only way out to make a diagnosis and to revive the patient.
Patient had severe headache since morning with nausea and now vomiting. There was profuse sweat on her forehead and body temperature was above normal. Patient was highly sensitive to light.
B.P. was 186/124 mmHg and Pulse was 94/m, full and hard with RR of 26/m and patient was unable to interpret her symptoms due to severe headache, nausea and dizziness. There were loud Heart sounds without any added sounds.
Not wasting much time, she was prescribed ADRENALINUM 0/1 (10 Drops – STAT) on tongue at interval of 5 minutes for next 15 minutes.
Patient felt comfortable within next 15 minutes and asked for water and initiated talk with attending consultant. She easily drank 2 glasses of water and within next 5 minutes interpreted the whole story that what actually happened to her in her own words.
B.P after 10 minutes noted was 170/120 mmHg and Pulse was 90/m.
Adrenalinum 0/1 was given after 10 minutes and B.P. could be noted (after 25 minutes from start) as 156/110 mmHg and patient was feeling much comfortable and was easily talking to her colleague and attending consultant.
After talking to her, it could be found that she is suffering from HTn since last 6 years and is regularly taking Allopathic Drug for Htn but still BP sometimes shoot up like this and she feels as if she would have brain hemorrhage.
She was kept under observation for next 30 minutes and blood pressure was monitored in final on discharge as 140/96 mmHg and patient went to her car walking with ease.
Afterwards, she took treatment for same and was fully recovered from her HTn within 6 months and all allopathic drugs were tapered off within initial 20 days.
Link to websitepage: http://drbindras.wix.com/clc3795#!emergency-case-of-the-week/c9b1
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