恩 沒當急診醫師與內挨醫師後 好久沒update treatment acute pulmonary edema這個topic 剛剛來交班 就想說 看看我前一陣子很推的電子資料庫Dynamed怎麼寫 恩 差不多 Treatment overview: * IV loop diuretics if evidence of significant fluid overload (ACCF/AHA Class I, Level B) for example, furosemide (Lasix) 40-100 mg IV bolus, double dose in 30 minutes if no effect increase dose or add second diuretic if inadequate to relieve congestion (ACCF/AHA Class IIa, Level B) continuous infusion of loop diuretics appears no more effective than intermittent boluses (level 2 [mid-level] evidence) *ventilatory support noninvasive ventilation may improve respiratory distress but effect on mortality or need to intubate unclear (level 2 [mid-level] evidence) intubation and positive-pressure ventilation if severe hypoxemia or respiratory acidosis *morphine sulfate may be associated with increased mortality in patients with acute decompensated heart failure, but patients given morphine more likely to be more severely ill and have active coronary ischemia (level 2 [mid-level] evidence) *short-term, continuous IV inotropic support (such as dopamine, dobutamine, or milrinone) may be reasonable in hospitalized patients with documented severe systolic dysfunction, low blood pressure, and significantly depressed cardiac output (ACCF/AHA Class IIb, Level B) monitor fluid intake and output, weight, serum electrolytes, blood urea nitrogen (BUN), and creatinine daily during use of IV diuretics or active medication titration (ACCF/AHA Class I, Level C) *vasodilators (IV nitroglycerin, nitroprusside, or nesiritide) may be considered as adjunct to diuretics to relieve dyspnea in absence of symptomatic hypotension (ACCF/AHA Class IIb, Level A) nesiritide (Natrecor) may not reduce mortality, rehospitalization, or dyspnea in patients with acute decompensated heart failure (level 2 [mid-level] evidence) and increases risk for hypotension nitrates for acute heart failure syndrome have insufficient evidence for effects on clinical outcomes invasive hemodynamic monitoring recommended if respiratory distress or clinical evidence of impaired perfusion with inability to assess intracardiac filling pressures clinically (ACCF/AHA Class I, Level C) pulmonary artery catheterization may increase adverse events (level 2 [mid-level] evidence) but does not reduce mortality or length of hospitalization (level 1 [likely reliable] evidence) consider ultrafiltration for refractory congestion (ACCF/AHA Class IIa, Level C), but comparisons with diuresis have inconsistent results (level 2 [mid-level] evidence) prophylactic anticoagulation with unfractionated heparin, low-molecular-weight heparin, or fondaparinux recommended unless high risk for bleeding (ACCF/AHA Class I, Level B, ACP Strong recommendation, Moderate quality evidence, ACCP Grade 1B, level 2 [mid-level] evidence); IMPROVE Combined Risk Calculator predicts in-hospital risks start (or continue) oral beta blockers (ACCF/AHA Class I, Level B) after optimization of volume status and successful discontinuation of IV diuretics, vasodilators, and inotropic agents; start at low dose and only in stable patients continuation of usual outpatient beta blocker regimen during hospitalization for decompensated heart failure does not appear to worsen symptoms or increase mortality or length of hospital stay (level 2 [mid-level] evidence) beta blocker therapy during hospitalization for decompensated heart failure associated with lower post-discharge mortality (level 2 [mid-level] evidence) start or continue angiotensin-converting enzyme (ACE) inhibitors (or angiotensin receptor blocker [ARB]) in stable patients prior to hospital discharge (ACCF/AHA Class I, Level B)
Posted on: Sun, 03 Aug 2014 11:57:13 +0000