3.6 CONGESTIVE HEART FAILURE / PULMONARY EDEMA
Severe congestive heart failure (CHF) and/or acute pulmonary edema is caused by acute left ventricular failure resulting in pulmonary congestion. Most commonly these conditions are the result of myocardial infarction, diffuse infection, opiate poisoning, inhalation of toxic gases and severe over-hydration. It is characterized by intense shortness of breath, cough, anxiety, cyanosis, diaphoresis, rales and/or wheezing. In extreme cases, patients will exhibit diaphoresis, restlessness, apprehension and may cough up pink frothy sputum.
ASSESSMENT / TREATMENT PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed.
3. Administer high concentration oxygen via non-rebreather mask.
4. Place patient in full sitting position as tolerated.
5. Determine patient's hemodynamic stability and symptoms. Continually assess Level of Consciousness, ABCs and Vital Signs.
6. Obtain appropriate history related to event, including Past Medical History, Medications, Drug Allergies, Substance abuse or Trauma (recent head injury/fracture).
TREATMENT
BASIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration of oxygen by non-rebreather mask.
4. Place patient in full sitting position as tolerated.
5. Activate ALS intercept, if deemed necessary and if available.
6. Initiate transport as soon as possible with or without ALS.
7. Notify receiving hospital.
INTERMEDIATE PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration of oxygen by non-rebreather mask.
4. ALS STANDING ORDERS
a. Provide advanced airway management (endotracheal intubation), if indicated.
b. Initiate IV Normal Saline (KVO) or Saline Lock while in transport.
5. Activate paramedic ALS intercept, if available.
6. Contact MEDICAL CONTROL.
7. Initiate transport as soon as possible with or without paramedics
8. Notify receiving hospital.
PARAMEDIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration of oxygen by non-rebreather mask.
4. Place patient in full sitting position as tolerated.
5. ALS STANDING ORDERS
a. Provide advanced airway management (endotracheal intubation), if indicated.
b. Initiate IV Normal Saline (KVO) or Saline Lock.
c. Administer Nitroglycerin (NTG) SL tablet; 0.4 mg (1/150 gr.) or NTG spray if systolic BLOOD PRESSURE is greater than 100. NTG may be repeated in five (5) minute intervals times two (2) as dictated by patient's Blood Pressure.
NOTE: If the patient has taken Viagra
d. Furosemide (Lasix): 20-40 mg IV push if not currently on diuretics, 40-80 mg IV push if patient is on diuretics. Contact Medical Control if systolic blood pressure is less than 100mmHg.
6. Contact MEDICAL CONTROL. The following may be ordered:
a. Repeat doses of Nitroglycerin SL or spray. NOTE: Administration of Nitroglycerin is contraindicated
if patient has taken Viagra
b. 1 Nitropaste to anterior chest wall.
c. Repeat doses of Furosemide (Lasix).
d. Morphine Sulfate: 2 mg to 5 mg IV push.
e. Vasopressors: Infusion rates determined by Medical Control.
- Dopamine infusion 2-20 g/kg/minute
- Dobutamine infusion 2-20 g/kg/minute
7. Initiate transport as soon as possible.
8. Notify receiving hospital.
MoonDragon's EMS Index Page
HELPFUL PRODUCTS & FURTHER EDUCATION
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
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