Acute PO management

Question 1

ABCDE approach

Answer 1

If critically ill

Include in assessment - ECG, CXR, echo, catheterise and implement strict fluid balance charting, serial weights, natriuretic peptide, troponin if ACS suspected, ABG

Question 2

Initial tx

Answer 2

Position (sit up)
Oxygen (high-flow)
Diuretic (furosemide IV)

Morphine (may be used to cause venodilation and reduce preload)
Anti-emetic (metoclopramide 10mg IV)
Nitrates in severe pulmonary oedema (GTN infusion if SPB > 110 or 2 puffs GTN spray if SBP > 90)

Question 3

Further interventions as required

Answer 3

Look for and tx underlying cause
CPAP if hypoxic despite above interventions
Inotropes and intra-aortic balloon pump in ICU if in cadiogenic shock (hypotension + overload)

Question 4

Long term HF treatments

Answer 4

Tx cause
ACEi, BB, diuretic

Cardiac resynchronisation therapy device if QRS significantly prolonged
Implantable cardiac defibrillator if at risk of ventricular arrhythmias