Hypertension sufficient to produce clinical end organ dysfunction most commonly in the brain, heart, and kidneys. Diastolic pressure usually exceeds 110 - 120 mm/Hg with common presentations such as severe sudden headache, sudden nose bleed, altered mental status, chest pain, or CHF.

1. Perform patient assessment and ABC's.
2. Assess and manage other identified problems according to appropriate protocol (i.e. chest pain).
3. Administer oxygen via most appropriate device to insure adequate patient oxygenation.
4. Position patient in semi-fowlers or with some elevation of the head.
5. Monitor vital signs in accordance with S.O.P. protocol. Confirm BP's by repeating each set of vitals in both arms.
6. Measure blood glucose with Glucometer if mentation is altered in any way.
7. Transport patient expeditiously, preferably code 1, Request ALS Intercept, keep patient calm.

INTERMEDIATE LIFE SUPPORT

1. Establish IV access of D5W or NS, set at TKO rate.
2. If documented blood glucose is below 80 mg/dl with associated signs and symptoms of hypoglycemia, administer Dextrose 50% in accordance with DIABETIC EMERGENCIES protocol.

ADVANCED LIFE SUPPORT

1. Attach and monitor ECG, treat arrhythmias per appropriate protocol.
2. Treat chest pain complaints as per chest pain protocol.
3. If patient presents with "Hypertensive Crisis", contact Medical Control and request Nitroglycerin and/or Morpine sulfate to decrease diastolic BP.
4. Use extreme caution in patients presenting with Hypertension secondary to a cerebral bleed. (Cushings Reflex), lowering the BP in these patients may decrease thier CPP, leading to decreased cerebral perfusion.