#SimBlog: Heart Failure

““A 69-year-old male is brought to ER by paramedics with the history of SOB for 6 hours progressively getting worse. No chest pain.””

— PMH: HTN.PCI to LAD 3 yrs. ago

Observations

A – Clear & self maintaining.

B – Rate 35, SpO2 88%.

C – Pulse 140, BP 190/95.

D – E4 V5 M6 pupils equal

E – Temp 36.9°C

Clinical Findings

• Cold, sweaty and in Respiratory distress

• B/L profuse crepitations on auscultation

• Raised JVP and pedal edema

Why We Simulated?

• Ageing of the population and prolongation of the lives of cardiac patients has led to an increasing incidence of heart failure (HF).

• Among patients hospitalised for HF, in-hospital mortality and length of hospital stay have decreased, despite an increase in the severity of HF.

References:

• UpToDate®: Prognosis of Heart Failure

Learning Points

1. Management of Heart Failure starts with simple measure: Oxygen and Sitting Up

2. Consider the full range of Drugs: Furosemide, GTN and Diamorphine.

3. CPAP may be appropriate – but be aware of removing oxygen whilst setting up the CPAP.

4. For a reminder of how to set up our CPAP: https://vimeo.com/100323900 (password: cpap)

5. Summarising treatments given and verbalising the next step is good practice – but it is worth making sure you team is aware you are doing it.

6. It is worth thinking why has this patient gone into Acute LVF as this may require intervention.

Edit & Peer Review by Rebecca Prest