DEAR DR. DONOHUE: About two weeks ago, I had such a terrible headache that I thought I was having a stroke, so my husband took me to the ER. They told me I was having a hypertensive crisis, put me on an IV drip and gave me IV medicines. I would like to know more about this. What is it? I have been under treatment for high blood pressure for a number of years. – B.N.

ANSWER: A hypertensive crisis is a blood pressure of 220 over 140 or higher, along with evidence that the high pressure is damaging body organs. Target organs include the heart, the brain, the kidneys and the lungs. Such high pressure can provoke a heart attack, a stroke or kidney failure, or fill the lungs with fluid that makes it impossible for a person to get enough air to sustain life. Pressure of that magnitude can also lead to a split in the wall of the aorta – an aortic dissection – and that can be lethal.

Symptoms of hypertensive crisis include a severe headache, a struggle to catch one’s breath, mental confusion, chest pain and blurred vision. Sometimes there are no symptoms. The only evidence that a crisis is occurring is the elevated pressure and laboratory evidence – such as an abnormal ECG – that organs are suffering because of the high pressure.

Treatment is, of course, lowering blood pressure. The goal is modest – a 10 percent reduction of blood pressure in the first hour. Too-rapid lowering of pressure can bring about its own set of complications.

More than half a million North Americans suffer a hypertensive crisis each year. Sometimes the crisis is precipitated by people becoming lax about taking their medicines. That certainly does not apply to all who suffer such a problem.

You and all people with high blood pressure would benefit from buying a blood pressure machine so close tabs can be kept on blood pressure changes.

DEAR DR. DONOHUE: I am a caregiver in a residential care facility for the elderly.

One time, while helping a resident give himself insulin, I accidentally pricked my finger with his used needle. Is there a chance that I would become infected and come down with the illness too? – E.T.

ANSWER: By “illness,” do you mean diabetes? If you do, the answer is no. Diabetes is not a transmittable illness. You don’t catch it from someone who has it.

Or do you mean an illness like hepatitis or AIDS?

If there was blood on the needle and if the patient had either infection (or some other infectious disease), then the possibility of transmission exists. The probability of transmission, however, is not high. The amount of blood on a needle used for insulin injection is quite small.

All the same, you should notify the head nurse or the supervisor of personnel that you had a needle stick injury so the appropriate steps can be taken.

All medical facilities, including nursing homes, need to have in place a written protocol that specifies what procedures are to be taken when there is an accident such as yours.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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