HPI:
_ hx of CHF
_ previous EF
_ med complaince
_ chest pain
_ productive cough
_ increase in LE swelling
_ tob use
_ PND (paranodysl noctural dyspnea)
—-
Exam:
CV:
_ LE swelling
_ No LE swelling
_ Pulm:
_ no resp distress
_ significant resp distress
_ CBTA, no rhonchi, no rales
_ rales, no rhochi
—-
___
Suspect CHF exacerbation.
Severity: severe
Precipitant likely: _
DDx includes:
ACS
COPD/reactive airway dz
PNA
Diagnostically:
EKG
CXR
CBC/BMP
Trop
Theraputic Plan for CHF Exacerbation:
- -Aspirin 162 mg PO
- -Nitroglycern 0.4mg SL
- -Nitroglycerin drip. Start 100mcg/min, titrate by 25mcg/min to symptomatic improvement and patient’s baseline presumed to be SBP 120
- -Enalapril 1.25 mg IV
- -Lasix home dose in IV form
- -BIPAP.Given resp status during ED course, no indication for emergent intubation at this time.
Dispo: Admission
___
Suspect CHF exacerbation.
Severity: mild
Precipitant likely: _
DDx includes:
ACS
COPD
PNA:
_ Not consistent with PNA iven afebrile, CXR not c/w PNA, no productive sputum cough, pt does not meet criteria for empiric abx and sufficiently low risk of concurrent PNA.
_ Empiric antibiotics administered given c/f PNA. Given pt meets sufficient number of constellation of symptoms characteristic of PNA (febrile, CXR c/f PNA, productive cough), as such empirically treated for PNA.
Diagnostically:
EKG
CXR
CBC/BMP
Trop
Theraputic Plan for CHF Exacerbation:
- -Aspirin 162 mg PO
- -Nitroglycern 0.4mg SL
-
-Enalapril 1.25 mg IV
- -Lasix home dose in IV form
Dispo:
_ Admission
_ Cardiac observation unit for moderate amount of diuresis
_ Home
*This information is intended for educational purposes only and not intended for use in patient care (which requires a trained credentialed attending physician and individualization of the medical care plan to the specific patient).