History/examination
inc. baseline observations (HR, BP, Temp, Resp Rate, Spo2, EWS, AVPU)
Investigations:
YES
- Consider NIV and referral to critical care
- Indications for NIV: pH <7.35 with PcO2 >6.0
NO
Consider i.v. opiate if severe anxiety/distress- Senior Review for decision to treat
- Consider referral to CCU or HDU
No additional therapy until response assessed
Consider vasodilator (e.g. GTN)
- EWS < 3
- Reduction in dyspnoea
- Adequate diuresis (>100 mL/h urine production in first 2 h)
- Accompanied by an increase in oxygen saturation (if hypoxaemic)
- Reduction in heart and respiratory rate (which should occur in 1–2 h).
- Full set of physiological observations (at least 4 hrly)
- Fluid balance (at least 4 hrly)
- Daily weight chart initiated (within 24 hrs)
HF team will review patients with BNP >400 within 24 hours of BNP result
Continue present treatment
Once the patient is comfortable and a stable diuresis has been established, withdrawal of i.v. therapy can be considered (with substitution of oral diuretic treatment).
Ensure Management of:
- Fluid overload (diuretics prescribed)
- Renal dysfunction
Repeat U&Es within 48 hours
ECHO performed within 48 hours of BNP
Ensure daily body weight is monitored for duration of admission- ECHO/Cardiology review (within 2 hours)
- Ceiling of Care
- BNP/Troponin Result
Seek urgent Cardiology review if:
SBP not maintained >85mmHg
OR
SpO2 <90%
OR