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Walking From Cleveland to Orlando: How Reducing Steps in Gathering Equipment Increased Amount of Work Hours Spent on Patient Care by Greene, Tracy; Howell, Diane; Shaarda, Jennifer; Weekley, Lonnie is a Medicine article available to read on EtoBox.

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Background: Tilt table test (TTT) is commonly used for dizziness work-up, that includes use of nitroglycerine(NTG) during provocation phase. Paradoxical hypertensive reaction to NTG is extremely rare. Pheochromocytoma rarely presents as dizziness and hypertensive emergency can rarely occur during TTT with NTG provocation in these patients. Case: A 51year-old woman with controlled hypertension underwent TTT for dizziness with sublingual NTG for provocation phase. Within 14 minutes, she developed hypertensive emergency, pulmonary edema and cardio-pulmonary instability with room air SpO 2 71%, heart rate 103 bpm and BP 273/158mmHg, cold, clammy and greyish skin. Possible anaphylaxis to NTG with hypertensive emergency was suspected and treated with hydralazine, metoprolol, intravenous methylprednisolone sodium succinate and diphenhydramine. Initially, epinephrine was withheld due to severe hypertension. Despite treatment, patient decompensated with further respiratory distress and developed hypotension. Epinephrine was given with respiratory support to stabilize her. She recovered uneventfully and was discharged home. Decision-Making: Possible anaphylaxis to NTG was suspected given the

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Author

Greene, Tracy; Howell, Diane; Shaarda, Jennifer; Weekley, Lonnie

Publisher

Elsevier Science; Wiley (John Wiley & Sons); John Wiley & Sons Inc.; Wiley (ISSN 0001-2092)

Published

2020

Language

EN

Field

Medicine (Health Sciences)