OnlineMedEd: Intern Content - "CHF II Hospital"

Question 1

How does SVR change in CHF?

Answer 1

It increases to maintain MAP.

Question 2

Review the warm, cold, wet, dry 2x2 table.

Answer 2

• Warm, dry: normal
• Warm, wet: fluid overloaded, diurese to become warm, dry
• Cold, dry: low-flow state, use vasodilators to increase perfusion
• Cold, wet: cardiogenic shock, give ino-dilators (dobutamine, milrinone) to improve flow

Question 3

How do you assess for volume overload?

Answer 3

The best diagnostic is catheterization with PCWP, but because this is invasive you should use history and physical exam to assess severity:

• History: DOE, orthopnea, paroxysmal nocturnal dyspnea, weight gain, abdominal pain
• Exam: peripheral edema, JVD, crackles

Question 4

Describe the method for assessing JVD.

Answer 4

If you can’t see it, the JVD level might be hiding behind the mandible. The level should become more apparent when lying flat. Have the person lie flat and watch the level. If it becomes apparent, then you know you can’t see it upright and there’s no JVD. If it doesn’t become apparent, then you don’t know where it is and JVD is impossible to assess.

Question 5

List things to assess in the history of someone with CHF.

Answer 5

• Fatigue
• DOE
• Mentation changes

Question 6

What vital sign might you see in someone with CHF cardiogenic shock?

Answer 6

Narrowed pulse pressure

Question 7

Do not give ____________ to those in cardiogenic shock from CHF unless they were taking it already.

Answer 7

beta-blockers

The acute drop in CO could worsen their shock.

Question 8

Review the management of CHF cold/dry shock.

Answer 8

The primary initial goal is reduction of afterload so that perfusion increases. Use CCBs, ACE inhibitors, or CCBS.

Question 9

Review the management of CHF wet/warm exacerbation.

Answer 9

The goal is diuresis with furosemide (can use 2.5x their home PO dose) or HCTZ.