Hypertension

• Signs: Common, immediate, probably transient, and characterized by excessive catecholamine (which may predispose to cardiomyopathy), increased cardiac output, and tachycardia. However, may persist beyond the acute phase

• Risk factors:
  • Severe injury
  • Focal insult to selective areas, such as the hypothalamus, periventricular nucleus, and orbitofrontal cortex

• Causes
  • Laboratory evaluation should be done to rule out neuroendocrine causes, renal or adrenal hemorrhage, and pheochromocytoma
  • Medications, such as steroids, should be evaluated for risk of hypertension
  • Episodic hypertension, accompanied by headaches and facial flushing, may indicate a spinal cord lesion
  • Other possible causes include pain from decubitus ulcers, poor positioning or splinting, and tracheostomy or gastrostomy sites

• Treatment
  • Usually with beta blockers that control blood pressure and have reduced cognitive side effects, such as atenolol, metoprolol, or nadolol
  • Calcium channel blockers and angiotensin-converting enzyme inhibitors in patients with motor impairment since they also help replete calcium, magnesium, and phosphate. Beta blockers may also be necessary to control reflex tachycardia. Exposure to beta blockers for either cardiac or non-cardiac reasons was associated with a significant reduction in mortality in patients with severe TBI, even in older, more severely injured, and with lower predicted survival. (Cotton, et al 2007).

Hypotension

• Causes:
  • Frequently due to prolonged immobilization, decreased plasma volume, or side effects of medications, such as antihypertensive agents, and especially diuretics, alpha blockers, and vasodilators
  • Can be secondary to hemorrhage or neuroendocrine imbalance in the early recovery period
  • Persistent hypotension can be due to autonomic or cardiac dysfunction
  • Profound hypotension may be associated with hypopituitarism

• Complications - Transient systolic hypotension (systolic blood pressure < 100 mm Hg) is associated with increased acute mortality and decreased functional status, and may have the greatest impact in patients with less severe primary injury (Winchell, et al 1996)

• Treatment is with compression garments, gradual upright positioning using a tilt table, and drugs such as ephedrine, if necessary

EKG Abnormalities

• Common during early recovery
• Due to myocardial ischemia or necrosis or to massive catecholamine release
• Dysrhythmias are relatively uncommon