Tuesday, November 22, 2016

Heart Failure Management

emDocs - November 22, 2016 - Authors: Jeffers K and Long B - Edited by: Koyfman A
  • Congestion will be absent from chest x-rays about 20% of the time… don’t be fooled. Bedside US can really benefit, and BNP may be used to help confirm the diagnosis in these patients.
  • Ultrasound is a great new addition to confirming the diagnosis of AHF.
  • The vast majority of patient presenting with AHF fall into the warm and wet category. Mainstay of treatment for these patients is diuresis. Start with their home dose of Furosemide/Lasix IV.
  • Patients presenting in acute pulmonary edema are going to respond best to vasodilators (nitrates), as diuretics will have little effect acutely.
  • BiPAP or CPAP should be used in the dyspneic patient.
  • Cardiogenic shock is rare but life threatening: Remember your ABCs.
  • Positive pressure from intubation further decreases preload and cardiac output which can worsen hypotension. Be prepared to counteract this (push dose epi… norepinephrine… dobutamine)
  • Dobutamine is first choice for low cardiac output.
  • Norepinephrine is the first choice vasopressor."