Management of Heart Failure in ED

Management of Heart Failure in ED from Sun Yai-Cheng

Management of Heart Failure in the ED Setting:
An Evidence-Based Review of the Literature

J Emerg Med, 2018 Sep 26.
doi: 10.1016/j.jemermed.2018.08.002

Management of Heart Failure in ED

hemodynamic stabilization and symptom relief
ABC

Mild AHF Exacerbation with Systemic Overload

• Diuretics (bolus or continuous infusion and high- vs. low-dose)
• Ultrafiltration for refractory AHF
• Morphine is not recommended

Hypertensive AHF with Pulmonary Edema

• NIPPV
• Nitrates (SL, IV)
• Diuretics

Hypotensive AHF with Cardiogenic Shock

• Inotropic agents (norepinephrine ± dobutamine)
• A small fluid bolus 250–500 mL
• NIPPV or ETT
• Mechanical circulatory support: IABP, VAD, V-A ECMO.

High-Output Heart Failure

• Treat underlying etiology

Disposition

• 80% admission
• Observation units

Heart Failure Risk Scores

• Ottawa Heart Failure Risk Scale
• Emergency Heart Failure Mortality Risk Grade

Af with AHF

• Cardioversion 
• Digoxin