Emergency Room Series: Severe Hypertension

Finally, the strike is over! Life returns to normal, no more massive crowds at the hospital, no more high accident cases or suicide cases, no more complex conditions, no more extra working hours. Sighs! 

We can finally breath. 

You know, I like to say that there's nothing more dear to you as your health, a good health actually. Everyday we leave our houses to hit the roads, going about our normal businesses and trying so hard to make ends meet in an economy and society that helps her people in very little ways. Most times people forget about visiting the hospitals until they are ill.

 Hardly would you find anyone going to the hospital for routine checkups, they think about the cost, waiting hours at the hospitals, traffic and that's enough to put anyone off. In reality, before anyone can show signs or symptoms of an illness, the body must have tried really hard to fight the disease. So I wonder why when the signs begin to show, people still try to 'manage' their health. Its really hard to blame anyone for 'patching' their health as the cost of quality private medical care is high.

 For those who can't afford it and choose to visit public hospitals, they'll have to wait for basically everything, from getting their records to seeing a doctor, getting drugs, booking appointments and so on. 

Anyways, to the story of today. A man in his early thirties was rushed to the ER, he was subconscious and restless. He looked pale and was mildly obese. He was said to have been playing sports a day before and started complaining of severe headache and chest tightness as soon as he got home. His wife claimed he was hypertensive and was not using his drugs regularly. He was said to have used paracetamol, his antihypertensives and a drug to help him sleep the previous night. 

He was discovered to be unresponsive the following morning by their maid who called his wife(they have separate bedrooms) and he was rushed to the hospital.
At the hospital, his blood pressure was discovered to be dangerously high. It was about 270/145mmHg. His oxygen level was poor, His skin was cold to touch, he was sweating and his eyes were not responding to light so well. He was breathing so fast and his heart beat was fast as well. He was not responding when called and would not respond to pain until he's given cardiac massage(when knuckles are used to forcefully rub the chest and cause pain to check for the level of consciousness).

He was moved to another unit where he was commenced on oxygen to help him breath better and had intravenous medications to crash the blood pressure. He also had medications to 'protect' his heart and medications to make him pee and reduce excess body fluids. He had an urinary catheter passed and he was able to make some urine although it was slightly bloody. Some of the urine was taken for testing as well. He equally had an ECG done as well. He had blood samples collected for series of test and they came back to be all bad especially the kidney function tests. He had high levels of urea and creatinine.

 His blood level was also low. He already had something we call 'acute kidney injury'. His kidneys were failing already. The doctors were thinking of moving him to a dialysis center for dialysis but he wasn't stable enough and his blood level was too low for that. 

After about 2 hours of treatment, his blood pressure began to reduce and he was able to mumble some words but was still very drowsy. He would move his hand to his chest and squeeze it as if he was in pain. He was reassured and given pain injections too. After about 30mins, his heartbeat began to rise again, and his blood pressure began to drop very fast, going from as high as 190/80 to as low as 54/42. The doctors immediately got the crash cart, getting ready for a possible cardiac arrest and some put up saline drips to raise the bp. It was surprising to us as to how fast the bp could crash. 

The doctors suspected the high blood pressure had caused a vessel to rupture and he was bleeding internally. Unfortunately, the heart stopped. CPR commenced, which was quite difficult because he was big and he had fatty breasts. CPR continued for about 30mins, in a desperate bid to restart the heart, but it never did, sadly. He was pronounced dead afterwards. his wife was there with him the whole time with a man who said he was his brother. She slumped on the floor in shock and was crying, I guess she was still processing what had just happened. The patient's brother who was with her requested that the hospital should refer the body to another hospital for an autopsy. He wasn't satisfied as to how sudden the man died. He said something about an ongoing legal case bla bla. 

The body was transferred to a federal hospital where an autopsy was done by a pathologist. As normal procedure, a copy of the result was sent to the doctor in charge of the case at our hospital which revealed he died of "aortic aneurysm, cardiomegaly and arteriolosclerosis". 

This is a man who everyone assumed was healthy. I assumed he did sports because he felt it was a form of exercise to lose weight. He could have as well been taking his drugs as prescribed. Hypertension is a very dangerous and silent killer. His condition caused him to have a swollen heart (cardiomegaly), a ruptured and internally bleeding blood vessel (aortic aneurysm) and hardening of arteries(arteriolosclerosis) and he was chubby, That was enough to kill someone who had underlying hypertension and wasn't regular on medications. 

To be honest, it is not easy to constantly be on drugs for a long time, it is time consuming and expensive. But nevertheless, it is important that people follow drug orders by their doctors. Please if you have anyone who has a long-term condition that requires medications everyday such as hypertension and diabetes, its important you ensure the person is religious with the drugs so as to live longer and avoid complications. Its also important they maintain an healthy body weight.