EMS Congestive Heart Failure

Learner responds to a 70-year-old male patient experiencing shortness of breath and chest tightness related to pulmonary edema. Learner should perform an initial assessment on scene, identify the patient’s dyspnea and hypoxia, and provide appropriate respiratory support. The patient is in respiratory distress and can speak in only 1-2 syllable words, with lung sounds demonstrating rales/crackles. 12-lead EKG shows sinus tachycardia with an LBBB without other evidence of STEMI or ischemia. Initial vitals are HR 120, BP 210/110, RR 32, SPO2 84% on RA, EtCO2 28. Critical actions include giving aspirin and placing on oxygen. This care should be initiated on scene and continued en route to the hospital, and the learner should give a report to the receiving team.

Advanced providers (ALS, SL4) should initiate CPAP ventilation.

Learning Objectives

– Assesses scene, identifying any potential safety concerns, number of patients, presence of bystanders, and additional resources available

– Conducts primary survey and obtains vital signs with attention to the following:
a. Determines level of consciousness and identifies mental status impairment
b. Identifies any signs of airway obstruction, hypoxia, or any observable breathing difficulties
c. Identify any profuse bleeding, signs of decreased or absent circulation, or any pulse deficits in extremities

– Performs immediate interventions to address concerns identified during the primary survey

– Determines priority of transport

– Conducts a secondary survey to gather additional pertinent HPI and PMH and conduct a focused physical exam

– Performs any necessary medical interventions to ensure patient stability and safety during transport

– Contacts Medical Direction when indicated

– Provides verbal report summarizing patient encounter

– Evaluates a patient suffering from respiratory arrest secondary to anaphylaxis

– Efficiently diagnoses angioedema causing airway compromise, and performs an immediate surgical airway