Ep 163 Acute Heart Failure ED Management – PoCUS, Oxygenation Strategies, Medication Strategies, PPV HAVoC and SCAPE

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 15 December 2021

⏱️ 66 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this Part 1 of our two-part series on acute heart failure, Anton is joined by Dr. Tarlan Hedayati and Dr. Bourke Tillman to answer such questions as: how does PoCUS compare with clinical assessment and CXR in diagnostic accuracy for acute heart failure? How do we best integrate PoCUS in the our assessment and management of the patient with acute heart failure? What is PPV HAVoC and how can we use it to optimize acute heart failure management goals? What should be our specific goals of management in the acute heart failure depending on the underlying cause? How does high flow nasal cannula (HFNC) compare to non-invasive positive pressure ventilation (NIPPV) in the management of acute heart failure? How should we interpret the C3PO trial in the context of the world's literature on NIPPV in acute heart failure? How should we dose nitroglycerin to maximize its effects without dumping the blood pressure in patients with SCAPE and those without SCAPE? How should we best time and dose furosemide in the acute heart failure patient with renal insufficiency? Is there any role for morphine or ACEi in the ED management of acute heart failure? What are best anxiolytic medication choices in acute heart failure? Is there any role for second line diuretics in the management of acute heart failure in the ED? and many more...

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases podcast.
0:05.0	I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC studios in Toronto.
0:13.9	EM cases is part of SREMI, Schwartz-Risman Emergency Medicine Institute, the nonprofit organization dedicated to improving EM care through research and
0:21.3	education. The opinions expressed on this podcast are intended for information and education
0:24.3	purposes only and should not be used to diagnose treat or prevent any medical condition,
0:26.4	nor should they be used as a substitute for medical advice from qualified practicing physicians.
0:29.0	I'm delighted to welcome back Dr. Tarlin Hediety, who you probably remember from our Bradacardia
0:34.6	episode. She's an EM doc in Chicago, an amazing educator with a special interest in cardiac emergencies,
0:40.4	and she was one of our featured speakers at the EM cases summit on November 11th on this very topic that we're going to be talking about today, acute heart failure.
0:49.3	And for his third or maybe fourth appearance on EM cases, Dr. Burke Tillman, EM trained intensivist at
0:56.0	Sunnybrook Hospital. Welcome back to you both. So great to be back. Thank you. Thank you for having
1:02.5	me again. All right. So this is part one of our Part 2 podcast on Acute Heart Failure. In this
1:08.7	part one, we're going to quickly review some diagnostic tips
1:11.5	and then dive deep into the specifics of managing the patient with acute heart failure
1:16.2	who is not in cardiogenic shock. And that includes Scape, which if you haven't heard of,
1:22.7	don't worry. We've got you've covered there. In part two, we'll cover the even more challenging patient
1:27.9	with acute heart failure and cardiogenic shock and wrap it up with disposition decisions,
1:32.6	including the clinical decision tools for safe discharge. Let's start with the diagnostic tips.
1:40.1	Some of the highlights that we talked about way back in episode four, which was in 2010.
1:46.0	So first, the history, based on the famous Jemma Rational Clinical Exam Series,
1:51.0	the historical features with the highest positive likelihood ratios for a diagnosis of heart failure are,
1:57.0	first, a past history of congestive heart failure with a positive likelihood ratio of 5.8,
	...

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