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HYPERTONIC CRISIS (HC)

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  1. Preparations for treatment of hypertensive crisis

This is a sudden significant elevation of arterial pressure that is, almost always, accompanied by the appearance or intensification of disorders in target-organs or functions of vegetative nervous system.

The criteria of hypertonic crisis are as follows: a sudden onset, significant elevation of arterial pressure and appearance or intensification of symptoms in the target-organs.

Table 14 Choice of agents in cardiac rhythm disorders

 

Character of disorder Conditions of origin Agents for treatment
Disorders of conduction:
1. Partial A-V node block Intoxication with glycosides, POC, myocardial infarction, operations on the heart Isadrin, ephedrine
2. Complete A-V block The same in a greater degree Artificial pacemaker
Disorders of automatism:
1. Sharp sinus bradycardia The same, and in addition -hyperkalemia, acidosis M-ChL (atropine), isadrin, ephedrine, agents norma­lizing AAB (soda, Trisbuffer)
2. Severe sinus tachycardia Activation of sympatho­adrenal system, overdo­sage of cholinomimetics /3-adrenomimetics, anticholinesterase agents, cardiac glycosides
3. Paroxysmal tachycardia Inderal, quinidine, ajmalin, potassium chloride, panangin, ethmozin
4. Atrial fibrillation and flutter a) on the background of cardiac failure; b) wthout expressed cardiac insufficiency Cardiac glycosides. Quinidine, ajmalin, inderal, ethmozin, defibrillation in case of ineffectiveness of medicamentous therapy
5. Ventricular extrasystole Hypoxia, hypokalemia, intoxication with glycosides, focal ventricular injuries Novocainamide, ajmalin, inderal, KC1, panangin
6. Polytopic ventricular extra-systoles The same Novocainamide i/v, inderal i/v, ajmalin, xycaine
7. Ventricular fibrillation Myocardial infarction, narcosis with halloid-containing agents and others Electrical defibrillation with maintenance of the effect with novocainamide or inderal

Depending on the expression of target-organs affection and necessity of urgent AP decrease we distinguish:

complicated crises with acute and progressing affection of target-organs that represent a direct threat for patient's life and demand urgent, in the course of 1 hour, AP decrease;

uncomplicated crises without affection of target-organs represent a potential threat for patient's life and demand fast, in the course of a few hours, AP decrease.


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