CHF / Pulmonary Edema

 

History:

 

  • CHF
  • Past medical history
  • Medications (Digoxin, Lasix)
  • Erectile dysfunction medication
  • Cardiac history (MI)

 

Significant findings:

 

  • Severe SOB
  • Air hunger
  • Diaphoresis
  • Tachypnea
  • Tachycardia
  • Chest pain
  • Elevated blood pressure
  • Peripheral edema
  • Pink, frothy sputum
  • Bi-lateral rales

 

CHF vs Differential:

 

  • MI
  • CHF
  • COPD
  • Asthma
  • Anaphylaxis
  • PE
  • Aspiration
  • Pneumonia
  • Pleural effusion
  • Pericardial tamponade
  • Toxic exposure

 

Treatment:

 

  • Oxygen
  • 12-Lead EKG
  • Initiate IV/IO

 

Consider Acute Coronary Syndromes Protocol

 

  • Assess symptom severity
  • Allow patient to maintain a position of comfort (usually sitting)

 

MILD?

 

  • Normal HR
  • Elevated or normal BP

 

Improving?

 

    • Yes

 

  • Notify receiving facility or contact Medical Control

 

    • No

 

 

      • Apply CPAP (EMT/Medic)

 

 

MODERATE/SEVERE?

 

  • Elevated HR
  • Elevated BP

 

 

 

  • Apply CPAP (EMT/Medic)

 

 

    • Notify receiving facility or contact Medical Control

 

CARDIOGENIC SHOCK?

 

  • Bradycardia
  • Hypotension

 

  • Remove CPAP, but only while hypotensive (SBP <90) (EMT/Medic)

 

 

 

 

  • Notify receiving facility or contact Medical Control

 

PEARLS:

 

  • Withhold Nitroglycerin in any patient who has used an erectile dysfunction medication in the past 24 hours
  • Systolic blood pressure must be greater than 100 for Nitroglycerin administration if 12 lead EKG and peripheral IV are not available. Blood Pressure must be obtained again prior to additional administration of Nitroglycerin.
  • May be repeated at 5 minute intervals if dyspnea is not relieved and systolic blood pressure remains greater than 90.
  • For Conscious Sedation, see Sedation/Anxiety protocol. Dose should be titrated to provide comfort without causing unconsciousness ore respiratory failure. Be sure to monitor patient's breathing/ventilations, blood pressure and O2 saturation.
  • Once CPAP is in use, apply 1 inch Nitroglycerin Paste.
  • Nitroglycerin Paste is applied to upper chest and further doses of sublingual Nitroglycerin can be withheld. Remove paste and wipe chest clean if systolic blood pressure is less than 90.
  • Morphine is not indicated in the presence of CHF.
  • Be sure to monitor patient's breathing/ventilations, blood pressure and O2 sat.