What is EMS Field Identification of CHF?
Congestive heart failure (CHF), a condition where the heart can’t pump blood well enough to meet the body’s needs, can be caused by many things. Some of these include drug overdose, infection of the heart muscle, heart attack, chronic high blood pressure, among others. This condition may also develop suddenly (acute) or over time (chronic). Depending on whether it’s acute or chronic, symptoms can vary from mild to severely life-threatening. It’s important to understand that CHF, regardless of its severity, can become an emergency situation if not properly managed.
What Causes EMS Field Identification of CHF?
Congestive heart failure (CHF) starts when the heart can’t keep up with its usual tasks. To understand how CHF works, we first need to understand how a struggling heart tries to keep pumping blood effectively.
Risk Factors and Frequency for EMS Field Identification of CHF
Nearly 5.7 million people in the United States are affected by CHF, making it the fastest growing heart disease in the country, as reported by the American Heart Association. The body has several strategies to keep the heart working properly and ensure the organs are getting enough blood. However, these strategies, which are mainly controlled by our nervous and hormonal systems, can sometimes fail.
Signs and Symptoms of EMS Field Identification of CHF
Congestive heart failure (CHF) is a condition where the heart does not pump blood effectively, leading to an accumulation of fluid in various body parts. Some key signs of CHF include the following:
- Jugular Venous Distention (JVD): This is when the veins in the neck become swollen with blood because of reduced blood flow back to the heart.
- Shortness of Breath and Rapid Breathing: Due to fluid in the lungs, which decreases gas exchange leading to breathlessness. Rapid breathing is the body’s way of trying to exhale excessive carbon dioxide.
- Rapid Heart Rate: Also known as tachycardia. This happens because the heart tries to return blood to the lungs as quickly as possible for oxygenation.
- Crackles in the Lungs: When fluid fills the air sacs in the lungs, it can cause crackling sounds when you breathe. These are usually first noticed in the lower parts of the lungs.
- Swelling in the Feet and Legs: Known as pitting pedal edema, this occurs when fluid accumulates in the tissues, causing swelling.
Capnography, a test that measures the amount of carbon dioxide in your breath, may show normal levels and waveform in people with CHF, unlike in conditions such as bronchospasm where the levels and waveform would be abnormal.
Testing for EMS Field Identification of CHF
The process of diagnosing in the field (outside of a traditional healthcare setting) involves a thorough review of the patient’s past medical history and a detailed physical examination. Unfortunately, there are no additional tests available outside of a health center.
Treatment Options for EMS Field Identification of CHF
The main aim of treating a condition known as Congestive Heart Failure (CHF) is to lessen the strain placed on the heart. This is achieved by boosting the amount of oxygen received through extra supplied oxygen, boosting airway pressures, and decreasing what’s known as “pre-load.”
A patient may receive supplemental oxygen through various methods, including a nasal cannula (a device that delivers oxygen through the nose), a non-rebreather mask, or preferably, if the patient can handle it, through a Continuous Positive Airway Pressure (CPAP) machine. The CPAP machine applies constant pressure to the alveoli, which are tiny air sacs within the lungs. This opens any alveoli that may have collapsed (a situation called atelectasis), and raises the pressure in the alveoli, which helps to push fluid back into the small blood vessels in the lungs.
Additional medicines, such as nitroglycerin or other vasodilators, help to widen the blood vessels. This process is known as vasodilation and can lower the pressure in the small blood vessels, contributing to the effects of CPAP by helping to actively push fluid back into the bloodstream from the air sacs in the lungs.
These vasodilators and the CPAP machine should be used with care, particularly in patients with low blood pressure (typically considered less than 90-100 mmHg) and/or recent use of drugs for erectile dysfunction. If there’s any uncertainty about using CPAP or nitroglycerin, it’s suggested to follow local medical guidelines or seek expert medical advice.
Waveform capnography is another helpful tool in monitoring the effectiveness of treatments for CHF. Capnography is used to help differentiate CHF from asthma or Chronic Obstructive Pulmonary Disease (COPD) when a patient has difficulty breathing. A normal capnography reading is rectangular, indicating the normal levels and removal of carbon dioxide in the body. Interestingly, patients with CHF can have a normal capnography reading, even if they are wheezing. This differs from the “shark fin” appearance of the reading that is typically seen in the case of bronchospasm, a condition usually related to asthma.
What else can EMS Field Identification of CHF be?
Some possible conditions related to lung or heart problems include:
- Acute respiratory distress syndrome (a severe lung condition causing shortness of breath)
- Bacterial pneumonia (a bacterial infection in the lungs)
- Cardiogenic pulmonary edema (fluid accumulation in the lungs due to heart problems)
- Chronic obstructive pulmonary disease (a long-term lung disease that makes it hard to breathe)
- Cirrhosis (scarring of the liver)
- Community-acquired pneumonia (a type of pneumonia you get when you are not in a hospital)
- Emphysema (a lung condition that causes shortness of breath)
- Goodpasture syndrome (a rare autoimmune disease that can affect the lungs and kidneys)
- Idiopathic pulmonary fibrosis (a disease that causes lung tissue to become thick and stiff)
- Myocardial infarction (a heart attack)
