URGENTELE HIPERTENSIVE ‘st omy: Livia POPESCU Conf. de Hon BitaN Denne: Ul ie geese i dak cto sto ees 1 sHiperesve emergence” eo pile tigen, car repre un stom cl ect pon coger nooo TA dase pee 150 lg, swt TAS pene 2) seg cate ig de deters (ne) a alsa le wpe ext Ek imp doe pi dvi de cna it 9 TA pin mete tava pr 4p uf we tne ‘vitae si viaja pacientulu, anes hes Stine + texan iperesv 1 pmesnes cat os EPA; 5 ponsns sci IMA 5 pees din AVC, 2 clinde oxrmoctons see mele cbeetd de eden rts ms 4 ancwsism seca de an; clampris pai, 1. ettypertensive urgent”, care incl sth in ete voile TA sant mult rected ms nsofese de fetes organo i, In aces sti TA tebe seizarelav urgent, da ny fsrte rapid deus de 24-48 oe, pind ules medi oral. eine 4+ HTA cu evolu aesera gi malipns, + HTA peopersire; 2 prechmpsn + Slalom! smpomai Aparatle interest: cardio-vascular ‘© pulmonar; orn Encefolopatia hipertensiva [ae un sinikom clinic acu earctiat pin manifest! neuro Topce dramatic: 1+ cfc general de intent resend ser] maeat, aga apo 4 Somalens, conic; 2 ‘ufurtvizuale pnd I pierre vedi; 4 gre gi vrs dtp cenal (pein hiperensane ita sro = coma si moat ‘Acct spore apar In Tips unor manifest neuroogie de foc. Ese produ de un edem cerebral dif datort vaso cxcesive a vaselr ecb cre gan depsit mecanamelefzloglee se eurcparetine Parxismelehipenensive: se evluea ca ected mari tensinale sistolo-iastolice (adesea pest 260/130 enti + aparlaintervaleneegulate te; sda vars (minutos) 4 sntspontae sau provocate (papuea abdomen, sf say ie a in ope, ma "+ suntinsfie de TRIADA ransiraiin access; + heeds, cefae. Diagnosis c + pin diese meiode initio: CT, RMN, ecograie, si wale abdomen: 4 dovate sanguin wnat a mtaneinlr ga meal Tort el mul 3 ze dup un episod de sl ipeeni (oid ani sande) Complcai: = "EPA 2 Ma 4 hemerasi coral; ture dem, Eclampsia preeclampsia ‘Preeclampsia ese un sndom speci sini caret rin 4 THTA ea valor constant reve protein, uur de veer: newoloie; deme perierie savin a 60% di sacle normale int mh repent clement dedagnost al reelampsi, ei media abe de men et 10 Eclampsia a ‘dem poplar a FO: convalsil generalize, ‘Sunt rspunoare de 1S in moraitte mater 1/4 din cea fe HTA cu evolutie acceleraté $i malign’ ‘eden pin uo ete = TAdasolct 2140 ots, 2 FOcuexsudt,temorapi elem papi: 1 modifies neuflogce cfale, confizie, sompolenA, sto- pore, seers vedi efite fos, contact, coms + insiiencarac, neuen renal revise ela a watamet; {crn api kexunlorhsloic fn ogale ts 2 hesrcd vino 9 profane minimala la nivel vase Nett are um progpostc fae rezervat, eves producing se ls 6 lanl am suprviines ls {an find de 25% iar Sade ‘ma 196 acai neeate Tramentl meer al HTA a ameliont prognostic acs cn lice, Soltultensional sever simptomatic Se caraceriaeas rn eryetea persistent valritr tension, reeves sponta tint: cue inten © algioracice;19. MANIFESTARI CONVULSIVANTE ‘Ao nv de GABRIEL ANGELESCU, ASSL wide ANCA MOLDONAN Dern Cena convlive reprezito alee brs a comprar, ‘ancerzath pin pce Senor su setae more cus Pa moietei le cone, datos activi else cole ase, Cele pot apirn ol sn ead ples ~ care ee 0 fear paris 3 fant eerbrale,caracterza prin en7e ub, seure, de alerares conten, produsd pin dsctearea excenivd reuroilor ceri $i eel norman con de serail, poste descre exces, determining coma Stare de ma convusiv se manifest in crize convulsive cae se clugese peste 1 minue sa aecese tonicaconie roesrive id ‘venta Sarea de conten dup Recaro, Eealogie: ples, nt de mci et a vascular: AVC hemorgi sa iscemie, infest - meningoeneaia; fer ~ convuls febrile apar I tempera peste 39°C, tn cara afer vile, afcjirlrbotrene,pstvaclnare; ‘tumor creel, primitive sau setae, ‘mab 4 edem creel: clamps, ncefulopatehperensiv; + toxic: medicamentoas, intxiap alco, don, Ae carbon, erganofostrce, eu plu Seam i simptome: Depind de pal erie, paral sau generis nize pri Aeseiraren neuonals se produce fn intrioral tne singe Terie torial in enzale generate descice snt dite ineresenr8 Sues cone Criee partie ptf simple ir piedeea contend exempl evr jocks rene, nd simple motor (Conractr muscular) Ince lamin se extn proximal, ptind-s geneaiza cul dine! pate bal fot tempera pare, expt controlar complexe ~c pedees conga inp de 1-2 minut pot plea lorie is origin nob tnpoal (clei tempor), Nu apa conval, exst amnezie postin. ‘Criele generalizae evolensh cu plrderea cantons si 8 fancier motor Fale ces suecdi etek de epilepseclasil sunt ‘yaar’ = ete 0 maniestre enzo gins pied are rece rz hlucinyi amveate ee), ‘faa convasv - perder conten, convalsile ocak rice, plafonrea ocr, migesile sada ale manus foemeazs ‘sue In gr se pote mse iby, lovire de compari din ju ‘faa deez (oscitcd) pom foare dif, ev ohm bile, confi sun atemm ise nat deme dt (Ciaeegenralizate sunt de tip: + fzcte de bsenh (ptt mal) x dara 10-20 seen, fk conv apa io general la coi, ei atte up ex, rk fot aceasa sven cee rand mal” sunt convuli tonic-clonic, precede aur, api piedrea content’ eee, Poe apes incontinent sneer, vezi anal, au dra 1-2 mints, Stans epilepticus ~acesle vin wl dap al, 8 put de ivitte neuen noms consi antral sleep dra den cteva ore la 12 ale. Pot apirentlburis esis respirie Cheyne Soke, sop espa, hpererefe taeo-brongic ‘ai ale TA care poste siden pin la cops Conia poset ‘ste mai lng dei dp eiza eign poate apie coc a fil 9 scsi 10% cara, Dingnost f+ stccedentl pacenuittamente vate; * dehutl gi modal de evolu « simply relate de cient (wator cular + aspect riz, evermentele ceo precd (oa). 0 Insese (cremplu,latralza, halcinti olfsetve sau gstve = spice in fetes lout temporal), o ume (poses), fan pita Alreroperea medias, de exemple + examenal cline general, newcogi, Ia nevoie pine evi prvizaea sti peulogce, sine asa fini cai ‘aseulae respite, ei soit Diagnostiaiternya 20% dine pace sut eet consier epileptic Se paste fate dagrostal ern l maniesor convulsive pe grpe devs: = adoesceni gi aul tines (1018 an 1.25 an sind de stn I aloo dog tumatome; ple, Lupene mecca nat de edn era zs dui up 25 ani: abstineny aloo: arog; tumor ere= tral; bolt mos; thar metabolic, aferfni degenerative: elapse “Ase, uebuie diferente tert ipur de rz ox: ‘incase poate 6 reflex, cardiac; na pesmi aa neon Vine rina ete rar, dezovintare poste rarer pezet, EEG somal 1 mires instlre len celech pols, carat de umicrni, BEG normal * hipoglicemia = vert capoele poplin dbo” sh llipogicemi oniabete + ean spasm muscu, compen pst + abut moter de orgine medicamentast:fenaizinse, Mtoclopramid pot inde dist de 1-15 mint, dr penal ete conten, EEG ete normal, manifest pairc cue: tac de nick ster, shi fren, bz de dogs, aac de eSdere (drop aac”) spar In are cardice, ischemic venebo-bzial, fuori vertebrobasilar, ioctl reurcptiperiferis, healaPakinso, saben vrs, ‘Tratamen Intoate esate: prevenirea mugcii ail -cu tej su lea dni, rin inroderen Inte nade 2 uni roy de compress, prevent traumatsmelor din tnpul erik ped sub cap: hinele dese in ji pits 1 dezobstruci ore-farngian (ae a proezle mobile); {+ plasarenpacientai in porte lateral de seeuritae pests sesitaaspati #0; pemase; 1 abord veno periterie- dif erat, nd necesare dou reroane: vn nobles raul, cal pine o vers mae, ‘moniorizare TA, AV Tempera, el glicemie, suri nos,Ze os ain de mens ret 4 sdminstare de medicament anconvlsvct ot monies exist un medicament care fie sigur feet nce pei Dovel se adminsuears ia fance de rete, vist est nese monitorizan nivelulor seice i ute posible reac avers, * Comist generalize ~ medicament de ales este uel sine: ‘+ Fenton (Diana) comprimate 100 mg, 20040 mei, medi terapeut 1020 igh, ‘+ Fens (Lumina) comprise 15 mg, 100 mg. Hoke 200 mg? ml 40m ml medi rape 1030 mp + Carbamazeping Tegretol 600-1 200 mg, in 2-4 pe, edie terapetcd 412 mga: Acid valproic Depakine) 7503000 main 13 pie + Frosximids,Cloazepan (Riv, * Conv seneriste ante prin consum de alco! sav lle sth toxiedezechilbe meubolce: ‘+s adminiseeard iv. Gucos 10% sa le 339% 10m cet ge Weve acd este ipoglicemi i contin uadminsares tv. Chor Sr ‘+ daca anu ntowcage alcool, penta a preven oe ‘xflopate Werke se administer vitamin B10) 95 Fv. In'-8 mint, spot peizie eu Gucor 9, fa eve Diazepam injectabil 1020 mg iv, maxim 100 m2 oe Convulsitpafate: wna nae umaearee: Fenn; Carbo. marepin; Fear Conifer: ari i cabinetl sontloge: 1 delete ee rateable Assuminaen supcioare su ra 1015 mpg cordza sau Thupten 10 ks corpo + aor sntndeat anon; Fenokita 10-15 mpg corp iv + Feieina 10-15 mph emp i Acid valproic, Pale Preeitiaconvulsor febrile: Acctaminofen sau Ibuprofen ls 0 temperature peste 38 C; la fea de peste 385°C: Diazepam ini rev, dove adapt une de vr. 2 Sata ppc —urgen Diary mae 100 mg24 or 2 Lonuepam § mei,