Guidelines for ED Observation of Congestive Heart Failure
May 1, 2002 less than 1 minute read
Guidelines for ED Observation of Congestive Heart Failure
TRANSFER CRITERIA
- Previous history of congestive heart failure
- Acceptable vital signs: Blood pressure >100/60, Respiration rate <32, Pulse <130
- Pulse-oximetry >80 on room air, correctable to >90 on oxygen
- High likelihood of correction to baseline status within 24 hours — consider discussion with private medical doctor
EXCLUSION CRITERIA
- Unstable vital signs
- New onset congestive heart failure
- Associated unstable angina, chronic obstructive pulmonary disease, myocardial infarction, sepsis, pneumonia, new murmur, confusion
- Electrocardiogram changes
- Severe anemia (Hemoglobin <8)
- New arrhythmia
- Respiratory failure, intubation
POTENTIAL INTERVENTION
- Telemetry Monitor System monitoring
- Oxygen per respiratory guidelines
- Serial exams, vital signs, electrocardiograms, cardiac enzymes, and pulse-ox checks
- Medication — diuretics, vasodilators, ACE Inhibitors, inotropics (Consider stopping medications with negative inotropic effects)
DISPOSITION
Home — Acceptable vital signs
- Return to baseline status
- Pulse oximetry >90 on room air unless previously on home oxygen
- Electrocardiogram unchanged from baseline
- No chest pain or dyspneu at rest
Hospital — Worsening respiratory status
- New electrocardiogram changes, arrhythmia, or ischemia
- Persistent hypoxia, rales, dyspnea
- Failure to return to baseline status within 18-hour timeframe
2/27/98
Source: William Beaumont Hospital, Royal Oak, MI.
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