Management of Congestive Heart Failure: An Approach for the New Millenium (1997-12-08)

Congestive Heart Failure, Pulmonary Edema, and CPAP James Pointer, MD, FACEP Medical Director Alameda County EMS

Objectives ,[object Object],[object Object],[object Object],[object Object]

Terminology ,[object Object],[object Object],[object Object]

Etiology ,[object Object],[object Object],[object Object],[object Object],[object Object]

People Live With Atherosclerosis – But Die of Thrombosis! Arteriosclerotic plaques gradually narrow the coronary arteries, but it is a rupture of the plaque and subsequent platelet aggregation and thrombosis that occludes the artery. Acute Myocardial Infarction

Heart Failure - Concepts ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Three Pathophysiological Causes of Failure ,[object Object],[object Object],[object Object]

Compensatory Mechanisms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CHF Vicious Cycle Low Output Increased Preload Increased Afterload Norepinephrine Increased Salt Vasoconstriction Renal Blood Flow Renin Angiotension I Angiotension II Aldosterone

Decompensation ,[object Object],[object Object],[object Object]

Infiltration of Interstitial Space ,[object Object],[object Object],[object Object]

Acute Pulmonary Edema a true life- threatening emergency

Precipitating Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Physical Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

EMS Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CPAP - Introduction ,[object Object],[object Object],[object Object]

Key Points of CPAP ,[object Object],[object Object]

CPAP Mechanism ,[object Object],[object Object],[object Object],[object Object]

Prehospital Indications ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],Prehospital Indications - Patient Assessment

Absolute Contraindications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Relative Contraindications ,[object Object],[object Object],[object Object],[object Object]

Complications ,[object Object],[object Object],[object Object]

Using the Machine ,[object Object],[object Object],[object Object],[object Object],on/off Flow O 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Important Points ,[object Object],[object Object],[object Object]

Important Points (cont.) ,[object Object],[object Object]

CPAP vs. Intubation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CPAP Study 1996 – 1997 1997 – 1998 September – May September – May Intubated 22 8 CPAP 0 50 Hospital Stay(d) 14.8 8 ICU Admission 100% 48%

Alameda County Data ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Summary ,[object Object],[object Object],[object Object],[object Object]

Management of Congestive Heart Failure: An Approach for the New Millenium (1997-12-08)

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Management of Congestive Heart Failure: An Approach for the New Millenium (1997-12-08)