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A 72-year-old female with a past medical history of Alzheimer’s dementia is transferred from her SNF with hallucinations and agitation. On ED arrival, she is looking around and appears to be responding to internal stimuli. She is not following commands, picking off the EKG leads, pushing the healthcare technician away from her, and anytime someone tries to start an IV or put a blood pressure cuff on her, she swings at them and has already punched EMS and one of the nurses. She is unable to be verbally redirected for IV establishment but allows you to get an EKG and opening set of vitals, which are normal. What's your next step in evaluation and management?
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The emDOCs team is happy to be reposting Ultrasound G.E.L. content in their never ending coverage of evidence based ultrasonography (EBU). In this post, does combining multiple POCUS for PE make for a more accurate exam?
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Acute heart failure exacerbation disposition
Not all patients require admission
Consider patient hemodynamics, respiratory status, ECG, labs (Cr, troponin, sodium/electrolytes), ability to ambulate, follow up
Elevated troponin and serum Cr associated with worse outcomes
Don’t use risk tools alone for DC, but Ottawa Heart Failure Risk Scale may assist in admission (ACEP Level B)
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