Algoritma Hipotensi/Syok dan Edema Paru Akut Tanda kins: syok, hipoperfusi, g2gal jantung kongestif, edema paruakut ‘apalah masalahmya? ¥ Edema panu alt Masaleh volume Masai pompa Masaih ama Tsetanperame ie || sertan aye oz imunesiaeas 1» Geran spastic cereerguten) craglcerin strat, oserice VO ertimbangkan: ameingit esopeesa? ¢ Morptin 2 mg eran, oer mm 79 70-00 mm yp 70200 mm teniuteen te Tenda/gepte syac | | | Tende/gejeiesyacie] | | tence/aeee ayoe b) ‘Undetan becue Noesnetin Sapamine centering 05 —20 yin 2-20 ur/eg/ome ov 2~ 20 yefeg/nme nv Tindaken fini kedua Nitrogliserin frtrat bila TD > 100mmntig Depamin bila TD 70-100 mmbe den tandasyok Debutemin bila 7D 70-100mmls tampa tandasyok ‘Pertimaengean ciegrantix dn terapi tut: Temuren pewenenisin eeveteriny eres punane ‘Tembenin provedur diagnostic essen oiresortc balloon pump aangiograt oun inerrant gorener Algoritime Hipotensi/Syak dan Edema Paru Akut (Madifkasi dan AHA guidetineGuidelines for the Management of Pulmonary Oedema in Patients with Kidney Failure Patient has Renal Falure and evidence of ‘Significant fuid overload andlor pulmonary oedema I ‘Stop all iv fuids,restit ora fuid intake, nurse in upright poston, administer 100 % oxygen, use oxygen saturation monitor, monitor hourly urine output l Patient is anuric andlor in respiratory | YES distress andlor isa known dialysis patent? NO + Patient previously on oop diuretics? Contact the on-call Nephrology Consultant for advice, and consider discussing with [100%02, CPAP (favalabe), W nate infusion, IV éamorph or morphine and loop diuretics (Cue to venodatory effects) can buy some time, but he definitive treatmentis usualy alysis] Intensive Care. Give iv furosemide 100mg, Double dose every 60 minutes toa maximum of 400mg as per clinical response and as alloned by carciovascular status ‘Give iv furosemide 40mg. Double dose every 60 minutes to @ maximum of 320mg 2 per clinical response and as allowed by cardiovascular status ae Patient responds fo treatment (reduced shortness of breath, and diuresis >3Omih)? —— Patient responds to treatment (reduced shortness of breath, and diuresis >30mhr}? YES No Discuss case with Medical SpR andlor Nephrologist on-alo establish most ‘appropiate ward for ongoing care 1. Give iv nitrates (isoket 0.05% startng at ‘mf cardiovascular status alows (avoid if systole BPt00mmH, then give fy diamorphine ‘ormorphine I Patient responds to treatment (reduced shortness of breath, and curesis 30m? Yes 1. Review hourly to consider further iv diuretics. 2. Discuss case with Metical SpR andior Nephrologist on- call to establish most appropriate ward for ongoing care No Contact on-call Nephrology CConsuitant andr Intensive Care for further advice Beware of ototoiity wit rapid infusions of arg doses of oop diuretics: give at a maximum rate recommenced in BNF (4rglin for furosemie)