It is 5:25 AM, Kaiser Emergency Department, and to my surprise I have time to write this blog. That means that all of our patients have been discharged--for a moment at least. This also illustrates that not everyone that comes through the door is a trauma. I thought it might be interesting to write a blog about a seemingly non-intense case to paint a more realistic picture of the emergency department. At least temporarily. It is just like the World Series of Poker that I always get caught up watching. Only the exciting hands make it to our television screen but the actual game is made in all the hands that are thrown away without any fanfare.
Today, a woman came to the ED with a chief complaint of elevated blood pressure. She checks her blood pressure every morning and it hovers around 130/90. But after a stressful day at work and having not checked it in the morning she visited a friend who also had a home blood pressure machine, checked her blood pressure, and was terrified to discover it had reached 170/100.
This case was an easy one for me. And, sometimes I look forward to those easy ones during a busy day. I think we all do.
Blood pressure rises with stress and anxiety. A one-time reading above baseline is nothing to get worked up about, and getting worked up about it just makes it go even higher. We only treat elevated blood pressure when it is also associated with other clinical problems such as stroke or vision changes. That usually doesn't result from one high reading. In fact Franklin Roosevelt was known to be travelling around the country with a blood pressure consistently above 250/150. There are long term consequences to this that require lifestyle changes and medical management but nothing we will do in the ED. The hard part was making the woman calmer. Her blood pressure did go down to 130/90. Now that's an effective treatment.