High BP After surgery

[Pissbrainiac259]

This is not the first place i go for information. I have talked to the surgeon, he doesn't say anything. Any side effects i have had he seems to put off on my GP to solve. And probably is worried i will blame the surgery and sue him maybe. And my GP says anesthesia can have that effect to some degree for 3 months, which i knew from my own reading. But it has been about 11 weeks and it is not getting better. It is not high enough to get many Dr's to worried. But i am looking long term and am proactive myself. I feel BP and glucose levels are 2 things that should be tracked and dealt with as soon as possible. I see that some of the antibiotics can effect BP but i quite them a while ago. And the DR's were not to up on that.

We usually don't get concerned until the systolic reaches and remains at > 180 mm Hg or DBP > 120 mm Hg (hypertensive urgency) for several straight minutes without abatement. Then you push an anti-HTN agent such as IV Labetalol, Nicardipine, Hydralazine, Enalaprilat, etc. depending on the pt's existing co-morbidities. Some clinicians prefer to use Oral forms of anti-HTN meds for hypertensive urgencies but the onset of action can vary significantly. Thus, IV is better, IMO, simply b/c of it's fast onset of action and ease of titration.

Then you have hypertensive crises (emergencies) where the SBP > 220 and/or the DBP > 120. Same rules apply with regards to meds used but you have less time to act. You must also lower the BP slowly at ~20-25% in the span of mins to two hours. If you lower it too fast, you can cause an ischemic stroke which last I check is no bueno.

 

[OuchThatHurts]

You're not being a dick. It is. Systolic minus diastolic. But he was talking about BP because he said 90s/60s and then 95/62. That would be a PP of 30s. Not 60s. And a diastolic of 30, he'd be in the hospital.

 

[Pissbrainiac259]

Not to be a dick

But isn't pulse pressure the difference between top and bottom number

Correct.

SBP - DBP = pulse pressure
MAP = (1/3 x SBP) + (2/3 x DBP)
Estimated CrCl via the Cockcroft-Gault Equation = [(140 - age in yrs) x weight in kg] / [(serum Cr in mg/dL) x 72] {in women x 0.85)
Anion Gap = Na - (Cl +HCO3)
Urine Anion Gap = (Sodium in urine + Potassium in urine) - Chloride in urine
Osmolarity Gap = (2 x Na) + (glucose /18) + (blood urea nitrogen/2.8)
Per Guyton's Textbook of Medical Physiology, the osmolarity of a healthy adult human is ~288 mOsm/kg

My personal favorite for last: A-a gradient = PAO2 - PaO2

There are many more important equations one should commit to memory to be efficient.

 

[maldorf]

Correct.

SBP - DBP = pulse pressure
MAP = (1/3 x SBP) + (2/3 x DBP)
Estimated CrCl via the Cockcroft-Gault Equation = [(140 - age in yrs) x weight in kg] / [(serum Cr in mg/dL) x 72] {in women x 0.85)
Anion Gap = Na - (Cl +HCO3)
Urine Anion Gap = (Sodium in urine + Potassium in urine) - Chloride in urine
Osmolarity Gap = (2 x Na) + (glucose /18) + (blood urea nitrogen/2.8)
Per Guyton's Textbook of Medical Physiology, the osmolarity of a healthy adult human is ~288 mOsm/kg

My personal favorite for last: A-a gradient = PAO2 - PaO2

There are many more important equations one should commit to memory to be efficient.

How about cardiac ouput= SV x HR.

 

[OuchThatHurts]

Correct.

SBP - DBP = pulse pressure
MAP = (1/3 x SBP) + (2/3 x DBP)
Estimated CrCl via the Cockcroft-Gault Equation = [(140 - age in yrs) x weight in kg] / [(serum Cr in mg/dL) x 72] {in women x 0.85)
Anion Gap = Na - (Cl +HCO3)
Urine Anion Gap = (Sodium in urine + Potassium in urine) - Chloride in urine
Osmolarity Gap = (2 x Na) + (glucose /18) + (blood urea nitrogen/2.8)
Per Guyton's Textbook of Medical Physiology, the osmolarity of a healthy adult human is ~288 mOsm/kg

My personal favorite for last: A-a gradient = PAO2 - PaO2

There are many more important equations one should commit to memory to be efficient.

How about cardiac ouput= SV x HR.

Damn it, I'm going to have to have to create a cheat sheet for these. I've left everything to my cardiologist and hematologist. This is exactly why I'm against staff and members dispensing medical advice and 'help' on the board. We have enough armchair bro endocrinologists and pharmacologists. Is there is a member out there that has any level of certification (MD, post grad, RN, ER, etc) in these areas? It might be good to have someone to field these questions safely and responsibly. I have enough on my plate as it is I have no time to start hitting the books on this.

Contact me if you'd be willing to do that and I'll see about getting it pushed through.

Thanks in advance,

OTH

 

[Pissbrainiac259]

How about cardiac ouput= SV x HR.

Maldorf, that's an easy one ergo, I didn't include it.

 

[Pissbrainiac259]

Damn it, I'm going to have to have to create a cheat sheet for these. I've left everything to my cardiologist and hematologist. This is exactly why I'm against staff and members dispensing medical advice and 'help' on the board. We have enough armchair bro endocrinologists and pharmacologists. Is there is a member out there that has any level of certification (MD, post grad, RN, ER, etc) in these areas? It might be good to have someone to field these questions safely and responsibly. I have enough on my plate as it is I have no time to start hitting the books on this.

Contact me if you'd be willing to do that and I'll see about getting it pushed through.

Thanks in advance,

OTH

There are a ton of formulas I chose to memorize instead of having to look them up especially when seconds matter. Same goes with dosages with medications.