I'm back to two weeks of night float! Last night, I was called to the CCU to evaluate a patient who was SOB. My general impression upon walking into the CCU was an 82 year old male lying in bed with audible rales (no need for a stethoscope!). I ordered a STAT CXR and did a quick exam. He was tachycardic at 110BPM (sinus tach), BP was 170/90 and RR was 30. Skin was warm to the touch. No diaphoresis. No JVD. Minimal accessory muscle usage. Lung sounds were rales in all lung fields. Heart sounds were very hard to appreciate because of the noisy lung sounds. Abd was unremarkable. Extremities were negative for edema.
My initial impression was that this patient was experiencing pulmonary edema and needed Lasix, Nitrates and an Albuterol treatment, but I wasnt 100% convinced. I waited for the CXR which showed CHF. I treated the patient with Lasix 40mg IVP, NTG 0.4mg SL and an albuterol treatment (then continued a 40% vento mask). Within 20 minutes the patient was already feeling better.
The patient was admitted earlier in the day for PNA and COPD exacerbation. My thought on this is was the patient in heart failure from the beginning? I tried to find the admit CXR but I couldnt find his file. Hopefully tonight, I'll be able to do so.
What is your experience with CHF vs PNA vs ARDS and how do you go about treating it?
Heart Failure on Medscape
Acute Respiratory Distress Syndrome on Medscape
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