61 yr old Patient came to hospital with complaints of sudden onset dyspnoea since 1hr, he is known case of RHD,MVP,moderate MR,trivial AR,DM, HTN. O/e he is having basal crepts, Bp 180/100,HR 120 spo2 84% without o2. What's ur daignosis and line of management ...
cardiogenic pulmonary edema... diuretics(lasix) ..o2 supplement.. nebulisation wit duolin /budecort..prop up position..fluid restrictions.. input urine output cvp measurement..ecg showing vpc ..measure sodium potassium.. can be started on digoxin ..ace inhibitors..aspirin...nd metroprolol...
This pt had MVP MODERATe MR.acclerated hypertension had precipitated her into pulmonary edema.treatment IV DIURETIC NTG ACE INHIBITORS.keep negative balance 1 1.5 LITRE/day.watch for worsening of ARF.can add aldactone or éprelenon.
Acute breathlessness in this patient is due to acute left ventricular failure. X Ray Chest shows pulmonary edema. Manage in ICU with.. 1) BiPAP (Send ABG) 2) Inj Lasix 60 mg stat ,repeat 40 mg. Or Start Inj. Lasix infusion. Catheterise and monitor Urine output. 3) Inj NTG by infusion pump,Titrate according to BP. 4) Bedside 2 d ECHO.See if MR has progressed from moderate to severe,Any RWMA( ischemic component )responsible for acute failure. Look for LVEF %. 5) Oral Antihypertensives can be started (overlapping with tapering NTG as BP comes under control)Choice of Antihypertensives can be Beta blockers,in view of MVP,CCBs. Also ask the patient about History of stopping Antihypertensives (which appears most often the reason). 6) ECG shows occasional VPCs,due to Hypoxia or borderline Potassium. Replace Potassium,Check Mg++. 7) Fluid restriction 1 litre.Salt restriction. 8) His mild renal dysfunction is due to underlying Diabetic nephropathy. (Do his Albumin creat ratio and proteinuria later, once he settles down). Avoid any nephrotoxics. 9) Advisable Cardiac enzymes. 10) Repeat 2D ECHO once the failure improves and tachycardia settles down.
Diagnosis: A case of acute left ventricular failure. Treatmeant: Propped up position. O2 inhalation high flow as SPO2 is 84% only. Inj Frusemide 60mg iv stat followed by 40 mg once daily along with ARB or ACE inhibitor along with beta blocker. Duolin nebulisation 8hrly. Tab Doxophylline 400 mg bid. Fluid restrictions with input - out put chart. CVP monitoring. Digoxin can be started. ECG shows PVC and serum creatinine is high. Investigation: 2D echo and USG whole abdomen.
CARDIOMEGALY BILATERAL BATWING OPACITY SUGGESTIVE C H F ECG = SINUS TACHYCARDIA LAE VPC +
Acute pulmonary edema. Propped up position in bed, NTG and Frusemide, oxygen inhalation to relieve work of breathing. Monitor CVP and urine output. ECG also shows few VPCs get an echo done.
CHF with Pulmonary oedema 2D Echo Rx Diuretics disprin Doxophylline SOS Digoxin 25 mg od. Metoprolol 25 SR OD. Syrp cadiphyllate 2 tsf TID complete bed rest salt restricted diet limited water intake 1& half litre.
RX PROP UP O2 INHALATION INJ LASIX IV ARB BETABLOCKER SALT & FLUID RESTN DAPAGLIFLOZIN 5 MG OD
Acute LVF Get the ABG,BNP done Tx :NIV support,Lasix,NTG infusion,cvp monitoring,Elctrolyte correction accordingly.
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