cardiomyopathy with ef of 10%

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Specializes in Med-Surg, Tele, DOU.

Hey guys,

Anyone awake. I'm at work and have a patient with tachycardia and a EF of 10%. Coreg ordered with iv lasix. Due to SBP in 90s and knowing that I need to give coreg, I called on call resident to see where to go from there. Resident said to give the 40mg iv lasix. I am definitely concerned due to potential of drying patient out. BUN is definitely on a downward trend from previously and creatinine is also on a downward trend. Will be giving the IV lasix and watching but definitely concerned due to experiences thus far with the residents knowledge base. Not used to working in teaching facility. Let me know what you think.

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Specializes in Cardiac Telemetry, ED.

Not enough info. What's the rhythm? Is the pt. symptomatic? How much Coreg? Is Coreg new for them? Any peripheral edema? Lung sounds?

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I would be very careful giving coreg and lasixs with a bp in the 90's.

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How old is this person. Are they on a transplant list? I never had a person with EF that low. I wouldn't think they would live long no matter what kind of treatment they got.

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Specializes in ER/Trauma.

An EF of 10%?

I have dozens of questions to ask before I can answer yours...

cheers,

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I agree with Roy lots of questions.

I do know, when we had a pt with a similar EF of around 15% or so, the pt was on the transplant list, and we had orders to administer his meds even if his SBP was in the 90's. The guy was walking around with his SBP in the low to mid 80's most of the time. Sometimes even lower.

How much edema does the pt have and where ? What do the lung sound like? What is the baseline BP for the pt, and is he symptomatic?

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Specializes in tele, oncology.

Not enough info to go on in this situation.

However, I have had to take care of many patients over the last five years with EFs less than 20%. In general, with those patients, we gave the meds and then bit our nails as we monitored their pressures. Many of them sat with SBPs in 80-90's as a rule due to all of the meds they had to be on.

I've had several who we've had to use dobutamine with instead of Lasix, or switch to Natrecor instead.

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Specializes in CVICU.

We give lasix to this type of patient all the time... that being said, we also have a Pyxis full of all types of albumin :)

As for the Coreg - yes. I have never held Coreg, even for pressures in the 80s.

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Specializes in Management, Emergency, Psych, Med Surg.

I would have to see and assess the patient for myself before I could make a comment.

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Just wondering what happend to the patient?

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Specializes in ER/Trauma.
I have never held Coreg, even for pressures in the 80s.
(emphasis mine) Depends on how the patient presents upon assessment (and history). Symptomatic or not is a big key.

e.g.: If they're symptomatic and in the 80s/lower-than-baseline along with bradycardia, I'm not giving Coreg.

cheers,

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Specializes in CVICU.
(emphasis mine) Depends on how the patient presents upon assessment (and history). Symptomatic or not is a big key.

e.g.: If they're symptomatic and in the 80s/lower-than-baseline along with bradycardia, I'm not giving Coreg.

cheers,

Well yes, they were not brady and minimally symptomatic. You're right, it's all about the clinical picture.

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