Heart Failure in Adults

36

Acute pulmonary
edema

37

38

39

SBP>160 and/or
HR>100

SBP 100-160

SBP<100

Acute Pulmonary Edema

Algorithm
A = Annotation

42

See Emergent
Management algorithm,
box #28, Assess blood
pressure, perfusion and
volume status

40

Consider IV
beta-blocker

43

41

Volume
overload?

Yes

Loop diuretic, IV
bolus, consider IV
infusion
A

No
45

Symptoms
improved?

44

Nitroglycerin SL or drip

47

46

Yes

Stabilized?

Out of guideline consultation and/or

tertiary center referral
A

No

Out of guideline
Consider consultation:
Acute coronary syndrome
Myocarditis
Uncontrolled hypertension
Valvular insufficiency
Non-cardiac etiologies

Yes

No

52

48
51

Yes

49

ED observation
or short stay
admission?

Other causes?

No

No

Yes
50

53

54

Other IV therapies
having greater risk:
Morphine sulfate
Milrinone
Dobutamine

Consider emergent
imaging and/or
hemodynamic
monitoring

ED observation or shortstay admission, return to

algorithm #6, Initiate HF
Management

56
55

Back to algorithm
box #46,
Stabilized?

Yes

Symptom
relief?
No
58

57

No

Volume overload,
refractory to initial
therapy?

Source: http://www.icsi.org Institute for Clinical Systems Improvement March 2010

Reviewed by CQIC: June 2005, May 2007, August 2009, August 2011

Yes

Out of guideline
Consider consultation:
Ultrafiltration
Hemodialysis

Return to main
algorithm box #6,
Initiate HF
Management