Stroke
37th Critical Care Congress: Hypertensive Crises in Critical Care: Insights into Current Treatment Paradigms
Supported by an educational grant from PDL BioPharma
Estimated Running Time: 1.5 hours
Credit Available: March 2008- March 2009
Learning Objectives
At the conclusion of this activity, participants should be able to:
- Formulate strategies for the treatment of acute hypertension in subarachnoid, intracerebral and ischemic stroke, as recommended in current evidenced-based guidelines
- Review controversies related to perioperative blood pressure control in patients undergoing cardiac surgery
- Analyze case studies in hypertensive crisis management
- Assess clinical trail evidence supporting the role of intravenous antihypertensive agents in the management of hypertensive crisis
Target Audience
This continuing medical education offering is intended to meet the needs of any healthcare provider involved in the care of critically ill patients, including advance practice nurses, critical care nurses, intensivists, critical care fellows, anesthesiologists, internists, surgeons, cardiologists, pulmonologists, emergency medicine practitioners, neurologists, and respiratory therapists.
Obtaining Credit
Click here to complete the evaluation and credit verification.
Upon receipt, your certificate will be sent to you within 30 days.
If you have any questions, please contact the Continuing Education Department at 847-827-6869 or at education@sccm.org
Physicians/Physician Assistants
SCCM designates this educational activity for a maximum of 1.5 AMA PRA Category 1 CreditsTM. Physicians should claim credit commensurate with the extent of their participation in the activity.
Nurses
SCCM is approved by the California Board of Registered Nursing, Provider No. 8181, and the American Association of Critical-care Nurses (#00013930) and approves this activity for 1.5 contact hours.
Pharmacists
SCCM is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmaceutical education. This activity will provide 1.5 continuing education hours. (236-000-08-151--H01)
Faculty Disclosure Statement
Faculty reported the following disclosures for this activity:
William M. Coplin, MD, FCCM
Wayne State University
Detroit Receiving Hospital
Detroit, Michigan, USA
Consultant, Research Grant Recipient, Speakers Bureau: PDL BioPharma, Integra Neurosciences, Medivance, Inc., Astellas
Pharma US
John M. Luber, MD
Franciscan Health System Research
Center Board
Tacoma, Washington, USA
Consultant, Speakers Bureau, Grant Recipient: PDL BioPharma, Scios, Johnson & Johnson
Gene Y. Sung, MD
University of Southern California
Los Angeles, California, USA
Consultant: PDL BioPharma, TheMedicines Company; Grant Recipient, Speakers Bureau: PDL BioPharma
To here the complete presentation, click here
Publications
Seizures, Stroke, and Other Neurologic Emergencies. Adult Multiprofessional Critical Care Review, 2007.
Stroke is the most common neurologic cause for hospital admission in the United States. About 80% of strokes are ischemic, with the remainder divided between intracerebral hemorrhage and subarachnoid hemorrhage. The incidence of stroke is declining, coincident with – and probably in part reflecting – improvement in the treatment of hypertension. The association of stroke with hypertension, particularly intracerebral hemorrhage, has been slightly overstated in the past. (Blood pressures were often measured when the patient presented with the stroke, rather than seeking a documented history of hypertension; the same is true of many studies of hyperglycemia in stroke.) Other risk factors include diabetes, cardiac disease, previous cerebrovascular disease (or stroke), age, gender, lipid disorders, excessive ethanol ingestion, elevated hematocrit, elevated fibrinogen, and cigarette smoking. Smoking is the most powerful risk factor for aneurysmal subarachnoid hemorrhage. In younger patients (usually defined as those aged 55 years), one should consider abnormalities of antithrombin III, protein S, protein C, or antiphospholipid antibodies. Young stroke patients with marfanoid habitus should be worked up for homocysteinuria; the heterozygous state is associated with stroke, and many patients respond to pyridoxine treatment.
Click here to view the entire chapter, Seizures, Stroke, and Other Neurologic Emergencies.
For more information on caring for critically ill and injured patients, Adult Multiprofessional Critical Care Review is available for purchase from the Society of Critical Care Medicine. Click here for details or to add to your shopping cart.
Neurologic Support. Fundamental Critical Care Support, 4th edition.
Ischemic stroke usually occurs due to the thromboembolic obstruction of arteries. Evidence supports the use of intravenous recombinant tissue plasminogen activator during the first 3 hours of the onset of ischemic stroke in an attempt to dissolve the obstruction and restore blood flow, as advocated by the American Academy of Neurology and the American Heart Association (AHA).
Supportive care includes management of hypertension. Although elevated blood pressure is often present early, a decrease in pressure occurs in the first hours after stroke without specific medical treatment. No evidence defines a level a of blood pressure that requires emergent intervention. The American Stroke Association and AHA have consensus recommendations for candidates for thromboembolic therapy. Emergency administration of antihypertensive agents is not indicated in other patients unless the diastolic blood pressure is > 120 mm Hg, systolic blood pressure is > 220 mm Hg, or there is evidence of end-organ injury (pulmonary edema, myocardial ischemia, etc.). If treatment is indicated, the blood pressure should be lowered cautiously with a reasonable goal of lowering the pressure approximately 15% in the first 24 hours after stroke onset.
Click here to view the entire chapter, Neurologic Support.
For more information on caring for critically ill and injured patients, Fundamental Critical Care Support is available for purchase from the Society of Critical Care Medicine. Click here for details or to add to your shopping cart.