Ep 163 Acute Heart Failure ED Management – PoCUS, Oxygenation Strategies, Medication Strategies, PPV HAVoC and SCAPE

In this Part 1 of our two-part series on acute heart failure, Anton is joined by Dr. Tarlan Hedayati and Dr. Bourke Tillman to answer such questions as: how does PoCUS compare with clinical assessment and CXR in diagnostic accuracy for acute heart failure? How do we best integrate PoCUS in the our assessment and management of the patient with acute heart failure? What is PPV HAVoC and how can we use it to optimize acute heart failure management goals? What should be our specific goals of management in the acute heart failure depending on the underlying cause? How does high flow nasal cannula (HFNC) compare to non-invasive positive pressure ventilation (NIPPV) in the management of acute heart failure? How should we interpret the C3PO trial in the context of the world's literature on NIPPV in acute heart failure? How should we dose nitroglycerin to maximize its effects without dumping the blood pressure in patients with SCAPE and those without SCAPE? How should we best time and dose furosemide in the acute heart failure patient with renal insufficiency? Is there any role for morphine or ACEi in the ED management of acute heart failure? What are best anxiolytic medication choices in acute heart failure? Is there any role for second line diuretics in the management of acute heart failure in the ED? and many more... Podcast production, sound design & editing by Anton Helman Written Summary and blog post by Kate Dillon, edited by Anton Helman December, 2021 Cite this podcast as: Helman, A. Hedayati, T. Tillmann, B. Episode 163 Acute Heart Failure ED Management - PoCUS, Oxygenation Strategies, Medication Strategies, PPV HAVoC and SCAPE. Emergency Medicine Cases. December, 2021. https://emergencymedicinecases.com/acute-heart-failure-management-pocus-oxygenation-ppv-havoc-scape. Accessed [date] Go to part 2 of this 2-part podcast on acute heart failure Value of clinical exam findings and basic investigations in the diagnosis of acute heart failure Deep dive into value of BNP in ED management of heart failure: Journal Jam 12 BNP for Diagnosis of Acute CHF PoCUS is more accurate than CXR and clinical exam in the diagnosis of acute heart failure Assessment of the patient suspected of acute heart failure with PoCUS helps to differentiate it from other causes of shortness of breath, is accurate for the diagnosis of acute heart failure and can help elucidate the underlying cause. B-lines are only the start. Follow the links for more info on each of the PoCUS aspects of assessment of the patients with acute heart failure. * B-Lines on PoCUS are 94% sensitive, 92% specific for the diagnosis of acute heart failure Image: Avila, J., Kim, D. (2015, December 18). US against the World: Ultrasound in differentiating COPD from CHF. CanadiEM. Retrieved October 4, 2021, from https://canadiem.org/us-world-ultrasound-differentiating-copd-chf/. * Pleural effusion * Jugular venous distension POCUS Cases on LV Dysfunction with Rob Simard POCUS Cases on IVC and volume assessment with Rob Simard It is important to identify the underlying cause of acute heart failure to help guide...