Friday, April 1, 2022

AHF Management

emDOCs Podcast Episode 50 - March 30, 2022 - By Brit Long
Misconception #1: Diuretics are the mainstay of therapy in all cases of AHF
Pearl #1: In SCAPE, nitroglycerin and noninvasive positive pressure ventilation should be first-line therapies before diuresis.
Pearl #2: Several diuretic strategies can be used in patients with systemic congestion, and ultrafiltration may improve diuresis in patients refractory to IV diuretics.
Misconception #2: The safest way of providing nitroglycerin IV is to begin with small doses and titrate to relief of symptoms to ensure patient safety in those with pulmonary edema.
Pearl #3: Nitroglycerin IV in high bolus doses is safe and effective in SCAPE.
Misconception #3: Morphine is safe in AHF and should be administered in AHF.
Pearl #4: Morphine may be associated with harm in AHF based on observational data.
Misconception #4: In patients with cardiogenic shock and SBP <100 mmHg, dopamine is the best agent to improve cardiac output and perfusion.
Pearl #5 : Norepinephrine should be used instead of dopamine in cardiogenic shock with hypotension