EM Cases · Acute decompensated heart failure
Hypertensive cardiogenic pulmonary oedema — the phenotype resus station
ACEM Fellowship resus station testing bedside profile reading, oxygen and early NIV, vasodilator use by blood pressure, the diuretic response check, and recognition of cardiogenic shock.
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Study tools
Target exams
ACEMFRCEMABEMFRCPCCCFPEMEBEEM
Prompt
A warm–wet hypertensive patient in pulmonary oedema who needs oxygen, early NIV, a vasodilator and a loop diuretic — then turns cold.
Station brief
Format. Clinical-management (resus) station, 11 minutes. You are the EM consultant.
Candidate instructions. Assess and manage acute dyspnoea. Examiner plays nurse.[3]
References7ShowHide
- [1]Gray A, Goodacre S, Newby DE, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema. The New England journal of medicine, 2008.PMID 18614781
- [2]Cotter G, Metzkor E, Kaluski E, et al. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet (London, England), 1998.PMID 9482291
- [3]McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European heart journal, 2021.PMID 34447992
- [4]Mullens W, Damman K, Harjola VP, et al. The use of diuretics in heart failure with congestion - a position statement from the Heart Failure Association of the European Society of Cardiology. European journal of heart failure, 2019.PMID 30600580
- [5]Fonarow GC, Abraham WT, Albert NM, et al. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Archives of internal medicine, 2008.PMID 18443260
- [6]Peacock WF, Hollander JE, Diercks DB, et al. Morphine and outcomes in acute decompensated heart failure: an ADHERE analysis. Emergency medicine journal : EMJ, 2008.PMID 18356349
- [7]De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. The New England journal of medicine, 2010.PMID 20200382