Red flags
- Hypotension (cardiogenic shock)
- Hypoxia despite O₂/NIV
- Fatigue → intubation risk
- Cardiac arrest
First steps
- Sit upright, high-flow O₂
- IV access
- Furosemide 40-80 mg IV or 2.5× oral dose
- GTN infusion if SBP >110 (start 10 mcg/min)
- CPAP if SpO₂ <94% despite O₂
Key investigations
- 12-lead ECG (ischaemia, arrhythmia)
- Troponin, BNP, U&E, ABG
- Portable CXR
- Bedside echo (LVEF, valves)
Differentials
- ARDS
- Pneumonia
- COPD exacerbation
- PE
Initial management
- Address trigger: ACS → PCI; arrhythmia → cardioversion; valve → surgery
- Optimise chronic HF therapy on discharge (ARNI, β-blocker, MRA, SGLT2i)
- Fluid restriction 1.5 L/day
Referral
- HF specialist team
- Advanced HF centre if refractory
AI clinical assessment
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This tool is for educational and clinical support only. It does not replace professional medical judgment or institutional protocols.
