Hypertensive Crisis/Epinephrine Reaction

Hypertensive urgency is defined as SBP >180 mm Hg and/or DBP >110 mm Hg; these signs may be accompanied by headache, anxiety, shortness of breath (SOB) and epistaxis (nosebleed), and requires urgent evaluation.

Signs and symptoms#

sustained and/or significant elevation in blood pressure (SBP >250 mm Hg and/or DBP >130 mm Hg)
severe headache
confusion
blurred vision
chest pain
anxiety
shortness of breath
nausea and vomiting
swelling or edema
seizures
unresponsiveness

Action#

consider differential diagnosis of myocardial infarction, thyroid crisis, or dissecting aortic aneurysm
eliminate pain. If the blood pressure does not return to acceptable levels within a couple of minutes of onset or continues to increase, terminate dental treatment immediately
place the patient in an upright position
initiate basic life support (BLS), start cardiopulmonary resuscitation (CPR), and alert emergency medical services (EMS)
monitor vital signs
administer supplemental oxygen

Causes#

inadequate pain control
excess total volume of epinephrine containing local anesthetic
inadvertent intravascular injection of epinephrine containing local anesthetic

Related Pages#

Medical Emergencies

References/Websites#

References