Cardiac Asthma

Low complexity — Circulation

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Goals

  1. Recognise symptoms consistent with heart failure using the ABCDE method.
  2. Name the interventions to be applied in heart failure.
  3. Reason through possible causes linked to the case.

Anamnese

  • Name: Mr Dirks
  • Age: 76 years
  • Family: Married
  • Occupation: Retired
  • Cultural: Not known

AMPLE

  • A.Unknown
  • M.Perindopril and hydrochlorothiazide
  • P.Hypercholesterolaemia, hypertension and myocardial infarction (3 years ago)
  • L.Unknown
  • E.Sudden increase in dyspnoea

SBAR

  • S.Mr Dirks is admitted to your ward due to a respiratory tract infection. He has been treated with IV antibiotics for 5 days and has recovered reasonably well. He is now asking for help because he is suddenly becoming increasingly short of breath.
  • B.Mr Dirks is a 76-year-old man with a history of hypercholesterolaemia, hypertension and myocardial infarction (3 years ago).
  • A.See ABCDE
  • R.Please assess the patient using ABCDE and apply interventions where necessary.

Situation at the start of scenario

  • A.Clear, alert, audible breathing, anxious.
  • B.RR 23 breaths/min, symmetrical thoracic excursions, increased work of breathing, using accessory breathing muscles, distended jugular veins, basal crepitations over all lung fields, saturation 92%.
  • C.Pink colour, profusely sweating, CRT 1 sec, HR 103 bpm, strong regular pulse, peripherally cold and clammy, BP 164/75 mmHg.
  • D.Alert on AVPU, glucose 6.9, pupils PEARL.
  • E.Temp 37.3°C, visible oedema in lower legs. Urine output: spontaneous 150 ml 5 hours ago.

Situation at the end of scenario

  • A.Clear, alert, audible breathing, anxious.
  • B.RR 30 breaths/min, symmetrical thoracic excursions, markedly increased work of breathing, using accessory breathing muscles, distended jugular veins, crepitations over all lung fields, saturation 84%.
  • C.Pink colour, profusely sweating, CRT 1 sec, HR 118 bpm, strong regular pulse, peripherally cold and clammy, BP 184/87 mmHg.
  • D.Alert on AVPU, glucose 6.9, pupils PEARL.
  • E.Temp 37.4°C, clear oedema visible in lower legs.

Recommendations

  • Perform ECG
  • Chest X-ray
  • Blood samples