Chapter 17 Hypertension
1 What is considered high blood pressure or hypertension in a child?
2 If a high blood pressure is found incidentally by the triage nurse, what two questions should you ask before you get too worried?
“What size cuff did you use?” Inappropriate cuff size can give spuriously high or low blood pressure readings. They will be falsely elevated if the cuff is too small, and low if the cuff is too big. The width of the cuff bladder should be about 40% of the circumference of the arm measured at the midpoint between the shoulder and the elbow (technically, between the acromion and the olecranon). The cuff should encircle 80–100% of the circumference of the upper arm and be about two-thirds of its length.
3 Which patients need evaluation and treatment in the emergency department (ED), and which patients can follow up with their primary physician?
Workup and treatment: Clearly, patients with hypertensive emergencies should be treated in your department, with the initial focus on ABCs and rapidly establishing IV access. Those children experiencing hypertensive urgencies (i.e., severely elevated blood pressures without evidence of end-organ damage), should be worked up, treated, and admitted for further evaluation.
Discharge without workup: Patients being seen for another problem who were incidentally found to have mildly elevated blood pressures and are asymptomatic can be discharged to the care of their primary care physician. Ideally, the doctor should record several readings in a series of visits before confirming the diagnosis of hypertension (Fig. 17-1).
Figure 17-1 Approach to the initial emergency department triage and stabilization of the hypertensive child.
From Linakis JG: Hypertension. In Fleisher GR, Ludwig S, Henretig FM [eds]: Textbook of Pediatric Emergency Medicine, 5th ed. Philadelphia, Lippincott Williams & Wilkins, 2006, with permission.
