May have
- Severe shortness of breath starting over minutes to hours — usually in person with
known heart problems
- Shortness of breath worse when lying flat, wakes person at night
- Crepitations (crackles) and/or wheeze in lower chest
- Pink frothy sputum — in severe cases
- Peripheral oedema (swollen legs or ankles)
Check
- Calculate age-appropriate REWS
- Adult — AVPU, RR, O2 sats, pulse, BP, Temp
- Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
- Weight, BGL
- ECG
- Head-to-toe exam — with attention to
- Swollen legs or ankles — peripheral oedema
- Listen to lower chest for crackles and/or wheeze
- Raised jugular venous pressure
Do
- Sit person up
- Give oxygen to target O2 sats 94–98% OR if moderate/severe COPD 88–92%
- Put in IV cannula
- Give furosemide (frusemide) IV — 40mg straight away — may need to repeat in 30 minutes
- If systolic BP more than 100mmHg — give nitrate therapy under tongue
- Isosorbide dinitrate — 5mg
- OR glyceryl trinitrate 1 spray under tongue — 400microgram
- Always check BP before and after giving nitrate therapy
- If shortness of breath doesn’t improve — can repeat every 5 minutes
- Do not give nitrate therapy if person has used drugs for impotence
- Sildenafil or vardenafil in past 24 hours
- Tadalafil in past 2 days
- Monitor urine output — aim for 0.5mL/kg/hr — commence fluid balance chart
- Medical consult