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Permissive hypotension or hypotensive resuscitation [1] is the use of restrictive fluid therapy, specifically in the trauma patient, that increases systemic blood pressure without reaching normotension (normal blood pressures). The goal blood pressure for these patients is a mean arterial pressure of 40-50 mmHg or systolic blood pressure of ...
Cerebral infarction, also known as an ischemic stroke, is the pathologic process that results in an area of necrotic tissue in the brain (cerebral infarct). [1] In mid to high income countries, a stroke is the main reason for disability among people and the 2nd cause of death. [2]
Documented goals for blood pressure include a reduction in the mean arterial pressure by less than or equal to 25% within the first 8 hours of emergency. [7] If blood pressure is lowered aggressively, patients are at increased risk of complications including stroke, blindness, or kidney failure. [6]
High blood pressure accounts for 35–50% of stroke risk. [110] Blood pressure reduction of 10 mmHg systolic or 5 mmHg diastolic reduces the risk of stroke by ~40%. [111] Lowering blood pressure has been conclusively shown to prevent both ischemic and hemorrhagic stroke. [112] [113] It is equally important in secondary prevention. [114]
Guidelines on the choice of agents and how best to step up treatment for various subgroups in hypertension (high blood pressure) have changed over time and differ between countries. A Comparison of International Guidelines on Goal Blood Pressure and Initial Therapy for Adults With Hypertension (adapted from JNC 8 guidelines [ 1 ] )
For most people, recommendations are to reduce blood pressure to less than or equal to somewhere between 140/90 mmHg and 160/100 mmHg. [2] In general, for people with elevated blood pressure, attempting to achieve lower levels of blood pressure than the recommended 140/90 mmHg will create more harm than benefits, [3] in particular for older people. [4]
permissive hypotension: tries to balance temporary suboptimal perfusion to organs with conditions for halting blood loss by setting a goal of 90 mmHg systolic blood pressure [3] hemostatic resuscitation: restoring blood volume in ways (with whole blood or equivalent) that interfere minimally with the natural process of stopping bleeding. [5]
Hypertensive encephalopathy (HE) is general brain dysfunction due to significantly high blood pressure. [3] Symptoms may include headache, vomiting, trouble with balance, and confusion. [1] Onset is generally sudden. [1] Complications can include seizures, posterior reversible encephalopathy syndrome, and bleeding in the back of the eye. [1] [3]