Congestive Heart Failure and Pulmonary Edema

Question 1

What kind of pt hx should you get?

Answer 1

• OPQRST/SAMPLE
• Medications (Beta blocks, nitroglycerin, Lasix, Digoxin, erectile dysfunction)
• Hx of MI, CHF, COPD, PE Hx of DM, HTN

Question 2

What are some signs and symptoms?

Answer 2

• Chest pain
• SOB
• Orthopnea
• JVD
• Paroxysmal nocturnal dyspnea
• Accessory muscle use, inability to speak in full sentences
• Rales/Rhonchi
• Pink /frothy sputum
• Peripheral edema, apprehension
• Hypotension, shock

Question 3

What are the guidelines for SL1?

Answer 3

• General patient care
• Airway Management

Question 4

What are guidelines for SL2?

Answer 4

• Chest pain protocol
• Cardiac monitoring and 12-lead EKG
• EtCO2
• Consider CPAP
• Consider PEEP Valve

Question 5

When do you consider CPAP?

Answer 5

If SPO2 remains <90% after increasing O2 to 10cmH2O

Question 6

When do you consider PEEP Valve?

Answer 6

When using a BVM

Question 7

What are the guidelines or Sl3?

Answer 7

vascular access

Question 8

What do you do if a pts EKG shows ST elevation in the inferior leads?

Answer 8

Complete a Right Side EKG

Question 9

What is a contraindication for nitroglycerin?

Answer 9

If ST elevation is present in the right-side leads

Question 10

How is norepinephrine administered?

Answer 10

In a large vein with an infusion pump or 60gtt tubing

Question 11

What kind of equipment do you need for a nitroglycerin drip?

Answer 11

• At least one functioning IV
• Infusion pump and proper vented (NTG) tubing

Question 12

What do you need for patient monitoring?

Answer 12

• If pain resolve completely, maintain drip at current rate of administration
• If pain continues, increase the drip rate by 5mcg/min q 5 until pain resolves or SBP falls below 100mmHg
• If SBP falls below 110mmHg during titration, temporarily stop the NGT drip