Heart Failure in Adults. Acute Pulmonary Edema Algorithm.

[See Emergent algorithm box #28, "Assess blood pressure, perfusion, and volume status"]

[Return to algorithm box #6, "Initiate HF management"]

[ED observation or short stay admission, return to algorithm #6, "Initiate HF Management"]

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Source: Institute for Clinical Systems Improvement (ICSI). Heart failure in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Aug. 119 p. Heart Failure in Adults Acute Pulmonary Edema Algorithm Acute pulmonary edema A = Annotation SBP greater than 160 and/or HR greater than 100 SBP 100-160 SBP less than 100 See Emergent algorithm box #28, Assess blood pressure, perfusion, and volume status Consider IV beta blocker Volume overload? A Loop diuretic, IV bolus, consider IV infusion. A Nitroglycerin SL or drip. A Symptoms improved? Stabilized? A Out of guideline - consider consultation and/or tertiary center referral. A Out of guideline. Consider consultation: *Acute coronary syndrome. *Myocarditis. *Uncontrolled hypertension. *Valvular insufficiency. *Non-cardiac etiologies. Other causes? ED observation or short stay admission? A Return to algorithm box #6, Initiate HF Management Other IV therapies having greater risk: *Morphine sulfate. *Milrinone. *Dobutamine. *Nesiritide. Consider emergent imaging and/or hemodynamic monitoring ED observation or short stay admission, return to algorithm #6, Initiate HF Management Back to algorithm box #46, Stabilized? Symptom relief? Volume overload, refractory to initial therapy? Out of guideline. Consider consultation: *Ultrafiltration. *Hemodialysis. All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc