Oxford American Handbook of Cardiology (Oxford American by Jeffrey Bender, Kerry Russell, Lynda Rosenfeld, Sabeen

By Jeffrey Bender, Kerry Russell, Lynda Rosenfeld, Sabeen Chaudry

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11 12 CHAPTER 1 Cardiovascular emergencies Pulmonary edema: management Stabilize the patient Patients with acute pulmonary edema should initially be continuously monitored and managed where full resuscitation facilities are available. • Sit the patient up in bed. , COPD. • If the patient is severely distressed, the patient may require continuous positive airway pressure (CPAP) or mechanical ventilation. • Treat any hemodynamically unstable arrhythmia (urgent synchronized DC shock may be required, (p.

COPD. • If the patient is severely distressed, the patient may require continuous positive airway pressure (CPAP) or mechanical ventilation. • Treat any hemodynamically unstable arrhythmia (urgent synchronized DC shock may be required, (p. 78). 5–5 mg IV (caution: abnormal ABGs) • Frusemide 40–120 mg slow IV injection • Secure venous access and send blood for urgent blood work. • Unless thrombolysis is indicated, take ABG. • If SBP t90 mmHg and the patient does not have aortic stenosis: • Give sublingual nitroglycerin spray (2 puffs).

Above-knee DVT Thrombi within the thigh veins warrant full anticoagulation with LMWH/ unfractionated heparin (UFH) and subsequently with warfarin. Anticoagulation Heparin • LMWHs have now superceded UFH for management of both DVT and PE. They require no monitoring on a daily basis and allow outpatient treatment. • There must be a period of overlap between LMWH/UFH therapy and anticoagulation with warfarin until the INR is within therapeutic range and stable. • LMWH are administered primarily as a once-daily subcutaneous (SC) injection, and dosage is determined by patient weight.

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