Improving Acute Hypertension Management through Emergency Department Checklist

项目摘要 发展中国家约有10亿人患有高血压。这种可预防的风险 一个因素导致超过1000万人死亡，与心脏病发作、中风和 肾衰竭急性高血压急症是一种特殊的急症， 血压严重升高（收缩压≥180 mmHg或舒张压≥ 110 mmHg），并有主要器官衰竭的证据，例如，心脏、大脑、肺或肾脏。的1%左右 高血压患者在其一生中可能遭受这种病症。高血压的诊断 紧急情况需要仔细评估，包括血液化学测试和诊断成像以及 作为谨慎治疗，以避免血压急剧下降造成的伤害。 急诊科中急性重度高血压患者的比例可能高达 百分之五。这不是一个不必要的负担，特别是在发展中国家， 治疗和医生培训有限。美国的一项研究表明，即使在发达国家， %的高血压患者在急诊时接受了适当的终末器官损害检查。 因此，发展中国家的情况可能更糟。美国急诊学院American College of Emergency 内科医生（ACEP）还指出，目前还没有基于证据的指南用于治疗急性 艾德环境中的严重高血压。 在最近的过去，在地球仪的紧急护理环境中实施检查表 显示了在特定条件下患者管理和结果的改善。我们建议 制定并评估一份针对低收入人群急性重度高血压急诊护理的检查表 设置.这在过去没有尝试过，因此可能会导致新的实践发生变化 知识我们提出了一个准实验，前后，干预研究是为了评估是否 检查表改善急性重症高血压患者的急诊管理和预后 巴基斯坦的卡拉奇。我们开发了一个专门的数据采集系统，用于应急信息的采集 短期和长期的护理和患者结果。这项研究可以解决知识需求， ACEP确定的问题，如“什么是最佳管理.

Project Summary There are about 1 billion people living with hypertension in the developing countries. This preventable risk factor accounts for over 10 million deaths and a significant morbidity related to heart attacks, strokes, and renal failures. Acute hypertensive emergency is a specific emergency condition in which a patient presents with a severely elevated blood pressure (systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥ 110 mmHg) and has evidence of major organ failure, e.g., heart, brain, lungs, or kidneys. About 1% of hypertensive patients could suffer from this condition during their lifetime. The diagnosis of Hypertensive Emergency requires careful evaluation consisting of blood chemistry tests and diagnostic imaging as well as cautious treatment to avoid harm caused by the precipitous blood pressure drop. The proportion of patients with acute severe hypertension in an emergency department could be as high as five percent. This is not an inconsequent burden especially in the developing countries where resources for treatment and physician training are limited. A US study showed that even in the developed world, only six percent of hypertensive patients in the emergency received appropriate work-up for the end-organ damage. Hence, the situation in the developing country could be much worse. The American College of Emergency Physicians (ACEP) also noted that there are no evidence-based guidelines available for treating acute severe hypertension in the ED settings. In the recent past, the implementation of a checklist in the emergency care settings across the globe showed the improvements in patient management and outcomes in specific conditions. We propose to develop and evaluate a checklist specific to emergency care of acute severe hypertension in a low-income setting. This has not been attempted in the past, and hence may result in new, practice changing knowledge. We propose a quasi-experimental, before-after, intervention study is to assess whether a checklist improves management and outcomes in patients of acute severe hypertension in an emergency department in Karachi, Pakistan. We develop a specific data capture system for information on emergency care and patient outcomes in short- and long-terms. The study may address the knowledge needs identified by ACEP such as “what is the optimal management …as it related to patient outcomes?”