Pedal Edema vs. Chubby Ankles

[HERBIE1]

I would treat the wheezing, and reassess the lungs often. I would also ask how long his ankles were swollen. If they just got big in the last few days or so, then clearly it's an issue. He may very well have rales but the sounds could be hidden by the wheezing and/or diminished lung sounds. Often times I have had folks where I only hear wheezing, but after albuterol they open up enough to the point where you can hear the rales. A good indication would be if the broncodilators did little to alleviate his SOB, my suspicions would be leaning more towards failure.

He was normotensive, so I wouldn't be as concerned about acute heart failure. Were his other joints(knees, wrists, etc) just as "chubby" as his ankles? Sounds like your guy simply liked to eat.

As for describing his size, I would simply say in my comments(PRN) something like "A 45 year old, 150kg male found sitting, with moderate to severe resp distress..." That way you state right off the bat the person's size, and it would be obvious he was obese. Most forms have a space to list a patient's weight, but if you also include this in the comments, you emphasize a fact that is pertinent to the exam.

[tcripp]

Just one quick general questions here. I assume most areas treatment of CHF is NTG SL? As opposed to Lasix and Morphine?

Our CHF/Pulmonary Edema treatment plan is CPAP, NTG, albuterol, Lasix, morphine, dopamine and/or zofran.

So, question for those of you who have NTG and CPAP in your protocols. Any great ideas for administering the NTG once the CPAP mask is in place?

Toni

[paramedicmike]

Our CHF/Pulmonary Edema treatment plan is CPAP, NTG, albuterol, Lasix, morphine, dopamine and/or zofran.

So, question for those of you who have NTG and CPAP in your protocols. Any great ideas for administering the NTG once the CPAP mask is in place?

Toni

Gotta talk your MCP into transdermal NTG. Using the CPAP mask and SL NTG argument is a great place to start.

[tcripp]

Gotta talk your MCP into transdermal NTG. Using the CPAP mask and SL NTG argument is a great place to start.

We have both in our protocols. We use both as long as BP > 90 mm Hg.

[paramedicmike]

Then I think you're set. Locally we use nitropaste in place of sublingual when patients are placed on CPAP. It takes a little longer to see the effects but it is very effective.

[Bieber]

I would love to have nitropaste, and I think it was requested a while back but denied for some reason or another. As far as dealing with the nitrotabs and CPAP, it's a pain. You just gotta go through the obnoxious process of taking off the mask and popping one (or two, per your protocols) in and then refastening the mask.

Our CHF/Pulmonary Edema treatment plan is CPAP, NTG, albuterol, Lasix, morphine, dopamine and/or zofran.

Are those all by standing order?

[tcripp]

Are those all by standing order?

Why, yes, they are

[Bieber]

Why, yes, they are

Man, I want to come work for your service!

[tcripp]

Man, I want to come work for your service!

I feel very fortunate to work for a service that I believe is as aggressive as it is.

[usalsfyre]

So, question for those of you who have NTG and CPAP in your protocols. Any great ideas for administering the NTG once the CPAP mask is in place?

Toni

You don't want to pop the seal if possible as you'll promptly derecruit any alveoli you've gained.

I've been known on severe CHF'ers to dump the require 3 SL NTG under the tounge all at once and then move to a NTG infusion titrated quickly up to 50-100mcg/min.