Pulmonary edema resident survival guide: Difference between revisions
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==FIRE: Focused Initial Rapid Evaluation== | ==FIRE: Focused Initial Rapid Evaluation== | ||
A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients of | A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients of pulmonary edema in need of immediate intervention.<ref name="pmid23741057">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH et al.| title=2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. | journal=Circulation | year= 2013 | volume= 128 | issue= 16 | pages= 1810-52 | pmid=23741057 | doi=10.1161/CIR.0b013e31829e8807 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23741057 }} </ref><br> | ||
<span style="font-size:85%">Boxes in red signify that an urgent management is needed.</span> | <span style="font-size:85%">Boxes in red signify that an urgent management is needed.</span> |
Revision as of 19:59, 8 March 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief:
Overview
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Diagnosis
Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
FIRE: Focused Initial Rapid Evaluation
A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients of pulmonary edema in need of immediate intervention.[1]
Boxes in red signify that an urgent management is needed.
Abbreviations:
BU: Blood urea nitrogen;
COPD: Chronic obstructive pulmonary disease;
D5W: 5% dextrose solution in water ;
HF: Heart failure;
IV: Intravenous;
MAP: Mean arterial pressure;
Na: Sodium;
NSAID: Non steroidal anti-inflammatory drug;
SBP: Systolic blood pressure;
S3: Third heart sound;
Identify cardinal findings that increase the pretest probability of acute decompensated heart failure ❑ Dyspnea | |||||||||||||||||
Does the patient have any of the following findings that require hospitalization and urgent management? ❑ Severe decompendated HF:
❑ Dyspnea at rest manifested by tachypnea or oxygen saturation <90% | |||||||||||||||||
Yes | No | ||||||||||||||||
Admit to to a level of care that allows for constant ECG monitoring given the risk of arrhythmia | |||||||||||||||||
Initial stabilization: Assess congestion and perfusion: Identify precipitating factor and treat accordingly:
❑ COPD Treat congestion and optimize volume status:
❑ Low sodium diet (<2 g daily)
❑ Consider low dose dopamine infusion for improved diuresis and renal blood flow (IIb-B) Venodilators
Treat low perfusion:
Invasive hemodynamic monitoring: VTE prevention: Chronic medical therapy:
❑ DO NOT INITIATE ACE INHIBITORS during an acute decompensation Monitor laboratory tests: Management of hyponatremia:
❑ Optimization of chronic home medications | |||||||||||||||||
- ↑ Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH; et al. (2013). "2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines". Circulation. 128 (16): 1810–52. doi:10.1161/CIR.0b013e31829e8807. PMID 23741057.