2015+HFAESCEuSEMSAEM建议急性心衰院前和医院管理 .pptx

Recommendations on pre-hospital hospital management of acute heart failure;Introduction;;;;;Definition and epidemiology of acute heart failure;;Prehospital and early management strategies in acute heart failure;; One way to achieve early treatment in AHF is to initiate acute management in the pre-hospital setting. Indeed many diagnostic and therapeutic tools are now available in the prehospital setting before admission to the ED (i.e, in the ambulance) in some countries8. This includes natriuretic peptides measured using a point-of-care device, if the diagnosis of AHF is uncertain9, non-invasive ventilation (NIV) that has been shown to decrease intubation rates and improve early outcome in acute cardiogenic pulmonary edema8 and any recommended intravenous treatment of AHF, especially nitrates and furosemide.10 Pre-hospital management should not delay the rapid transfer of AHF patients to the most appropriate medical environment. Data derived from registries indicate that early therapy is critical in the management of patients presenting with AHF, it is therefore rational to initiate treatment as soon as possible along with relevant investigations 5,12. Furthermore, when the clinical diagnosis of AHF is unequivocal, based on clinical examination, treatment should begin promptly rather than waiting for further testing.;Initial clinical evaluationand investigations at arrival in the emergency department/coronary care unit/ intensive care unit (Figure 1);;;;;;Laboratory tests at presentation;;Role of nursing management in acute heart failure; A rapid nursing assessment should be undertaken to optimize the triage of patients to the appropriate level of care and inform the management plan. The ongoing monitoring for changes in signs and symptoms suggestive of a response to treatment should be no less than four hourly. This should include monitoring the hemo- dynamic, respiratory and mental status and fluid balance 24,25. The side effects of treatment, such