Evaluation of Prehospital Use of Furosemide in Patients with Respiratory Distress
| Autor: | Paul Mikkelson, David T. Overton, Jason Jaronik, William Fales |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Adult
Male Emergency Medical Services Michigan medicine.medical_specialty Pediatrics medicine.drug_class Emergency Nursing Furosemide Internal medicine medicine Natriuretic peptide Emergency medical services Humans In patient cardiovascular diseases Diuretics Aged Retrospective Studies Aged 80 and over Medical Audit Respiratory Distress Syndrome Respiratory distress business.industry Retrospective cohort study Middle Aged medicine.disease Pulmonary edema Heart failure cardiovascular system Emergency Medicine Female business human activities circulatory and respiratory physiology medicine.drug |
| Zdroj: | Prehospital Emergency Care. 10:194-197 |
| ISSN: | 1545-0066 1090-3127 |
| DOI: | 10.1080/10903120500541282 |
| Popis: | To evaluate the appropriateness of prehospital use of furosemide.All patients over 18 years old receiving prehopsital furosemide were retrospectively identified, and cases were matched to subsequent hospital records. Data collected included ED and hospital primary and secondary diagnoses, brain-type natriuretic peptide (BNP) levels and final disposition. Furosemide was considered appropriate when the primary or secondary ED or hospital diagnoses included congestive heart failure (CHF) or pulmonary edema, or the BNP was400. Furosemide was considered inappropriate when none of the diagnoses included CHF, when the BNP was200, or when an order for IV fluid hydration was given. Furosemide was considered potentially harmful when the diagnoses included sepsis, dehydration or pneumonia, without a diagnosis of CHF or BNP400.Of the 144 included patients, a primary or secondary diagnosis of CHF was reported in 42% and 17% patients, respectively. The initial BNP was400 in 44% of the 120 patients in which this lab test was obtained. Sixty patients (42%) did not receive a diagnosis of CHF, 30 (25%) patients had a BNP200, and 33 (23%) had an order for IV fluid hydration. A diagnosis of sepsis, dehydration or pneumonia without a diagnosis of CHF or a BNP400 occurred in 17% of patients. Seven of the 9 deaths did not receive a diagnosis of CHF. Furosemide was considered appropriate in 58%, inappropriate in 42% and potentially harmful in 17% of patients.In this EMS system, prehospital furosemide was frequently administered to patients in whom its use was considered inappropriate, and not uncommonly to patients when it was considered potentially harmful. EMS systems should reconsider the appropriateness of prehospital diuretic use. |
| Databáze: | OpenAIRE |
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