CHF & Nebs.

[1EMT-P]

You respond to a 59 y/o female patient complaining of fatigue, swelling of the abdomen & legs & shortness of breath. The patient states that she has not been feeling well and that she has gained 20 plus pounds in the last 10 days.

history of Anxiety, Depresion, Gerd, HTN, Sick Sinus Syndrome & Restrictive Airway Disease. The patient was on ASA, Albuterol, Lasix, Lopressor, Protonix, Xanax & Vitamin E.

[Ridryder 911]

It all depends. Does my patient have an obstructive disease process along with CHF. Detailed assessment along with the use of EtCo2 capnography will help determine this. As well is your med.'s going to be effective? Sometimes, obstructive problems can be relieved by an beta type bronchodilator, then treatment of CHF can be administered to shift the fluids. However; caution has to be sure of diuresising the obstructive respiratory patient.

Atrovent with its anticholinergic properties can actually increase CHF problems.

R/r 911

R/r 911

[Sdowler]

if you use a duo neb then the bronchodilator effects will be minimized and as long as there is no localised consolidation lasix may be in order.

[ERDoc]

Gotta agree with Rid. This is on a case by case basis. Sdowler, I'm not exactly sure what you are trying to get at.

[CBEMT]

"None of the above."

ASA, Nitro, nitro, Lasix if absolutely neccessary, and by that time we're usually pulling up to the doors.

Considering my IV was probaby enroute during all this, there usually isn't enough time for a med that's not going to do what the patient needs anyway.

That said, we aren't allowed Atrovent anyway.

[1EMT-P]

Sorry about that, but my pc crashed in the middle of my post. The patient's vitals were as follows: BP 140/100, P 78, RR 20, Spo2 94% on RA, SR/Paced 78. The patient states that her Dr. recently increased her Lasix to 80 mg and that her labs showed that her cholesterol and liver function tests were elevated. The pt's Dr. scheduled her to have an echo along with a stress test.

Allergies: Bumex, HCTZ, IVP Contrast, Motrin & Sulfa.

[MrSpykes]

Here protocols for "Acute Pulmonary Edema" are NTG and CPAP. If the lung sounds and Hx are present we have Albuterol and Atrovent.

[vs-eh?]

From the literature that I have read, CHF can be a difficult diagnosis even in hospital and with a chest x-ray...That is why I believe they (generally speaking) are shying away from diuretics prehospital. The risk/benefit in the face of a difficult diagnosis (electrolyte imbalance, etc...) leads to less use.

Generally speaking, our doctors do not want us using a bronchodilator with a prehospital diagnosis of CHF. Obviously if there are underlying pulmonary issues (COPD, etc) in addition to the query CHF, then the case by case basis comes into play.

Oxygen and nitro (single or double dose BP dependant) are our first line drugs and basically the only intervention that we take on CHF'ers +/- assisted vents with a BVM. Nasal intubation has grossly fallen out of favour and generally people will not use our ghetto PAI (midazolam and morphine) to knock a bad CHF patient down. Generally try to manage as best you can (unless pre-arrest) for more definative tx in hospital (CPAP, BIPAP).

Sulpha allergy and furosemide use are contraindications, no?

[whit72]

1EMT-P Wrote:

Sorry about that, but my pc crashed in the middle of my post. The patient's vitals were as follows: BP 140/100, P 78, RR 20, Spo2 94% on RA, SR/Paced 78.

How about her lung sounds, any pedal edema?

[firefighter523]

Going by the pts vital, this pt would have gotten a slow ride to the hospital on 4lpm 02, a 12 lead and IV. No drugs!!