Cardiac Asthma

Mid complexity — Circulation

Back to overview

Goals

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

Anamnese

  • Name: Mr de Kort
  • Age: 72 years
  • Family: Lives alone
  • Occupation: Retired
  • Cultural: Not known

AMPLE

  • A.Unknown
  • M.Antibiotics and high-volume IV fluids
  • P.Type II diabetes, hypertension and peripheral vascular disease
  • L.Unknown
  • E.Sudden increase in dyspnoea

SBAR

  • S.Mr de Kort is admitted to your ward for a urinary tract infection. He has been treated with IV antibiotics for 4 days, requiring high-volume IV fluids. He is now asking for help due to increasing shortness of breath.
  • B.Mr de Kort is a 72-year-old man with a history of type II diabetes, hypertension and peripheral vascular disease.
  • 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 22 breaths/min, symmetrical thoracic excursions, markedly increased work of breathing, using accessory breathing muscles, distended jugular veins, crepitations over all lung fields, saturation 90%.
  • C.Pink colour, profusely sweating, CRT 1 sec, HR 108 bpm, strong regular pulse, peripherally cold and clammy, BP 178/73 mmHg.
  • D.Alert on AVPU, glucose 7.2, pupils PEARL.
  • E.Temp 37.5°C, clearly visible oedema in lower legs. Urine output: spontaneous 100 ml 6 hours ago.

Situation at the end of scenario

  • A.Clear, alert, audible breathing, anxious.
  • B.RR 34 breaths/min, symmetrical thoracic excursions, markedly increased work of breathing, using accessory breathing muscles, distended jugular veins, crepitations over all lung fields, saturation 79%.
  • C.Pink colour, profusely sweating, CRT 1 sec, HR 130 bpm, strong regular pulse, peripherally cold and clammy, BP 203/89 mmHg.
  • D.Alert on AVPU, glucose 9.6, pupils PEARL.
  • E.Temp 37.9°C, clearly visible oedema in lower legs.

Recommendations

  • Perform ECG
  • Chest X-ray
  • Adjust IV fluid policy