emDocs - August 6, 2018 - Author: Long B. Edited by: Koyfman A
"Key Points:
- A variety of misconceptions are present concerning the ED evaluation and management of AHF.
- Patients with hypertensive pulmonary edema require nitroglycerin and NIPPV. Diuretics before these therapies can be harmful.
- Diuretics can be beneficial in patients with more subacute decompensation and systemic volume overload.
- Nitroglycerin in bolus doses is safe and can reduce need for ICU admission. It probably does not improve mortality.
- Morphine can be harmful; you have safer options to reduce preload and afterload (nitroglycerin and NIPPV).
- Disposition is a complex decision, but combining assessment of patient hemodynamic status, ability to follow up, lab markers/ECG, and risk stratification toolsmay allow patient discharge."