A patient has not taken his BP medications in the last 3 days because he ran out. He complains of a headache. BP is 250/170. What is your best option for treatment?

• A. Administer IV nitro if available
• B. Lower the blood pressure with oral meds
• C. Call EMS and monitor
• D. Get to the closest facility as fast as you can

Answer: (D)

When BP is extremely high and the patient has symptoms like a severe headache, this is a hypertensive emergency requiring urgent hospital-based evaluation and treatment. The on-scene goal is to get definitive care as quickly as possible, not to try to fix the problem with medications in the field. Oral antihypertensives won’t provide reliable, rapid control of such a high BP, and attempting to lower it without continuous monitoring can be risky. Administering IV nitro could be considered in specific situations, but it requires IV access, careful monitoring, and isn’t the default approach for all hypertensive emergencies. The safest, most effective action here is rapid transport to the nearest facility where IV therapy and full evaluation can be provided.