Heart Failure
Acute Heart Failure Management
- Treatment of pulmonary edema should be focused on ‘fluid redistribution’ and not ‘fluid removal’.
- First line: Nitroglycerin and NIV (start ASAP)
- Second line: ACE-I (in addition or instead of NTG)
- Third line: Diuretic like furosemide
- Morphine has NO ROLE in modern management of cardiogenic pulmonary edema
Acute Heart Failure and Cardiogenic Shock
- There’s minimal or no role for the administration of loop diuretics (Furosemide/Lasix) early in the management of Acute Pulmonary Edema. The majority of patients aren’t volume overloaded.
- Immediate care should focus on Non-Invasive Positive Pressure Ventilation and administration of nitroglycerin.
- In patients with End Stage Renal Disease, dialysis is what’s ultimately going to fix the patient.
NOT CARDIAC: Causes of non-cardiogenic pulmonary edema
N – near drowning…
O – oxygen therapy / post intubation pulmonary edema
T – trauma / transfusion (TRALI – transfusion-related acute lung injury)