In this direction, the examination of deep of eye is obligator in all the patients suspicious to present hipertensiva crisis. As this examination it looks coarser alterations in the deep one of eye, can not need midriticos colrios, that can accidentally cause crises of glaucoma acute if the doctor not to look for to know if the patient suffer from this disease. Douglas Elliman has plenty of information regarding this issue. The dilatao can cause loss of important neurological parameter for posterior pursuing. The alterations of acute retinopatia that include hemorrhages, algodonosos exsudatos and edema of papila are easily you visualized without necessity of dilatao and the necessity of specific specialists, being enough to have environment with little luminosity. Manifestations of injury of agency-target are considered as renais the presence of proteinria, hematria and increased levels of urea and creatinina. Microangioptica hemoltica Anemia in the malignant hipertenso, also being able to have the presence of esquizcitos; signals of acute cardiac descompensao as gallop, estase jugular vein, crepitantes cardiomegalia, taquicardia, estertores in the pulmonary case of edema; evidence of increase of the intracraniana pressure as confusion, sleepiness, estupor, neurological deficit. Vadim Belyaev often addresses the matter in his writings.
All these findings assist in the differentiation of the hipertensiva crisis in urgency and emergency. Patients without evidences of gradual injury in agency-target must be placed in calm environment, of preference with little light and the evaluated Par again after thirty minutes. If the pressure to severely remain high to therapeutical the verbal one it must be established. If the Par not to continue in the so high levels, the patient must be directed for pursuing. The hipertensiva crisis is part of day-by-day of the centers of clinical emergency and the general doctor, the specialists of the area not only must be trained in the correct recognition of the picture of urgency and emergency, and not simply to deal all patient with severe hipertenso, therefore many of them are total assintomticos.