{"id":8774,"date":"2025-09-26T20:17:14","date_gmt":"2025-09-26T17:17:14","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8774"},"modified":"2025-09-26T20:17:14","modified_gmt":"2025-09-26T17:17:14","slug":"the-canadian-association-of-emergency-physicians-caep-acute-heart-failure-best-practices-checklist-april-2025-comprehensive-practical-review","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/the-canadian-association-of-emergency-physicians-caep-acute-heart-failure-best-practices-checklist-april-2025-comprehensive-practical-review\/","title":{"rendered":"The Canadian Association of Emergency Physicians (CAEP) Acute Heart Failure Best Practices Checklist (April 2025) \u2013 Comprehensive Practical Review"},"content":{"rendered":"
\u00a0The Canadian Association of Emergency Physicians (CAEP) Acute Heart Failure Best Practices Checklist (April 2025) \u2013 Comprehensive Practical Review<\/div>\n
<\/div>\n
Source:<\/div>\n
Stiell IG, et al. CAEP Acute Heart Failure Best Practices Checklist. CAEP, April 2025.<\/div>\n
Introduction<\/div>\n
<\/div>\n
CAEP published the Acute Heart Failure (AHF) Best Practices Checklist in April 2025. This ED-focused tool bridges cardiology guidelines (ESC, American Heart Association (AHA)\/Heart Failure Society of America (HFSA), Canadian Cardiovascular Society (CCS)) with real-time emergency care by:<\/div>\n
\u2022 Providing stepwise diagnostic and therapeutic actions tailored to the Emergency Department (ED).<\/span><\/div>\n
\u2022 Standardizing care and enabling registry-ready data (vital signs, oxygen, diuretics, Non-Invasive Ventilation (NIV), di\u2026<\/span><\/div>\n
[2:34 pm, 25\/09\/2025] Dr Jamal Aldabbas Card Socity: Jordan EMS \u2013 Practical Prehospital Protocol for Acute Heart Failure \/ Pulmonary Edema<\/div>\n
<\/div>\n
(Adapted from ESC, AHA\/HFSA 2022, NICE 2025, Canadian and Australian EMS guidelines)<\/div>\n
<\/div>\n
Source references: Cureus (Sept 2025), Journal of Clinical Medicine (2025), ESC 2023, AHA\/ACC\/HFSA 2022, NICE 2025, Canadian EMS 2023, Ambulance Victoria 2024.<\/div>\n
<\/div>\n
Keynotes:<\/div>\n
1. Rapid Recognition (without physician)<\/div>\n
<\/div>\n
Practical EMS Rule for Acute Severe Dyspnea<\/div>\n
\u2022 Any patient presenting with acute severe dyspnea, inspiratory crackles, and low O\u2082 saturation should be treated as acute pulmonary edema\/acute HF until proven otherwise.<\/span><\/div>\n
\u2022 Supporting features: pink frothy sputum, orthopnea, tachypnea, tripod posture, hypertension, and history of heart disease or hypertension.<\/span><\/div>\n
\u2022 If the main finding is wheeze without crackles in a patient with asthma\/COPD \u2192 consider bronchospasm.<\/span><\/div>\n
\u2022 EMS does not need to confirm final etiology; aim = safe stabilization and transport.<\/span><\/div>\n
<\/div>\n
How EMS Can Recognize Acute HF<\/div>\n
\u2022 Primary clues: sudden severe dyspnea, crackles, low O\u2082 saturation.<\/span><\/div>\n
\u2022 Visual cues: upright sitting, agitation, pink frothy sputum.<\/span><\/div>\n
\u2022 Vitals: tachypnea, tachycardia, often elevated BP.<\/span><\/div>\n
\u2022 History clues: known HF, CAD, hypertension, recent fluid overload.<\/span><\/div>\n
<\/div>\n
If present, EMS should treat\/stabilize as acute HF\/pulmonary edema until confirmed in hospital.<\/div>\n
<\/div>\n
2. Stabilization: Airway, Oxygenation, and BP-Guided Pharmacology<\/div>\n
<\/div>\n
Primary Actions<\/div>\n
\u2022 Ensure ABC.<\/span><\/div>\n
\u2022 Position upright.<\/span><\/div>\n
\u2022 Monitoring: SpO\u2082, ECG, BP, RR.<\/span><\/div>\n
\u2022 Rapid history (CHF, meds, comorbidities).<\/span><\/div>\n
\u2022 Establish IV access.<\/span><\/div>\n
<\/div>\n
Oxygenation and Ventilation<\/div>\n
\u2022 First-line: CPAP\/BiPAP if available.<\/span><\/div>\n
\u2022 If not: high-flow O\u2082, SpO\u2082 target 92\u201396% (88\u201392% if COPD).<\/span><\/div>\n
\u2022 Prepare for advanced airway only if refractory hypoxemia\/impending collapse.<\/span><\/div>\n
<\/div>\n
Blood Pressure\u2013Guided Pharmacology<\/div>\n
\u2022 Hypertensive (SBP \u2265110\u2013120):<\/span><\/div>\n
\u2022 SL GTN 0.3\u20130.6 mg q5min, max 3 doses.<\/span><\/div>\n
\u2022 Check BP before each dose.<\/span><\/div>\n
\u2022 Contraindications: SBP <100, RV infarct, severe AS, recent PDE-5i.<\/span><\/div>\n
\u2022 IV GTN is hospital-based.<\/span><\/div>\n
\u2022 Normotensive (SBP 100\u2013110):<\/span><\/div>\n
\u2022 Prioritize CPAP + rapid transport.<\/span><\/div>\n
\u2022 SL GTN only if SBP stable + congestion severe.<\/span><\/div>\n
\u2022 Consider loop diuretic if known CHF + overload.<\/span><\/div>\n
\u2022 Hypotensive (SBP <100):<\/span><\/div>\n
\u2022 Avoid GTN and diuretics.<\/span><\/div>\n
\u2022 Cautious fluids if hypovolemic.<\/span><\/div>\n
\u2022 Prepare vasopressors\/inotropes under medical control.<\/span><\/div>\n
<\/div>\n
5. Role of Loop Diuretics<\/div>\n
\u2022 Not routine in EMS (ESC, AHA, NICE, Canada, Australia).<\/span><\/div>\n
\u2022 Consider only if: known CHF, on diuretics, volume overload, SBP \u2265100.<\/span><\/div>\n
\u2022 If given: IV furosemide 40\u201380 mg, or 1\u20132\u00d7 home dose.<\/span><\/div>\n
<\/div>\n
6. Non-Cardiogenic Pulmonary Edema (NCPE)<\/div>\n
\u2022 Causes: sepsis, ARDS, neurogenic, toxins, TRALI, high altitude.<\/span><\/div>\n
\u2022 In EMS: differentiation is unreliable.<\/span><\/div>\n
\u2022 Management: O\u2082 \u00b1 CPAP, supportive, rapid transfer.<\/span><\/div>\n
\u2022 Avoid GTN\/diuretics if NCPE strongly suspected.<\/span><\/div>\n
<\/div>\n
7. Special Populations<\/div>\n
\u2022 Pregnancy: avoid supine; left lateral tilt; O\u2082 \u00b1 CPAP; GTN only if SBP \u2265110; transfer to cardiac\u2013obstetric facility.<\/span><\/div>\n
\u2022 Elderly: higher risk of hypotension \u2192 check BP before GTN; avoid morphine.<\/span><\/div>\n
\u2022 Obesity: ramped position; ensure CPAP mask seal; higher pressures may be needed.<\/span><\/div>\n
\u2022 COPD\/Asthma: target O\u2082 88\u201392%; distinguish wheeze vs crackles.<\/span><\/div>\n
<\/div>\n
8. Contraindications to Nitroglycerin<\/div>\n
\u2022 SBP <100 mmHg.<\/span><\/div>\n
\u2022 Recent PDE-5 inhibitor use (sildenafil, tadalafil).<\/span><\/div>\n
\u2022 Severe aortic stenosis.<\/span><\/div>\n
\u2022 Suspected RV infarction.<\/span><\/div>\n
<\/div>\n
9. Documentation & Handover<\/div>\n
\u2022 Record vitals, SpO\u2082, ECG, NIV settings, GTN doses.<\/span><\/div>\n
\u2022 Note patient\u2019s response.<\/span><\/div>\n
\u2022 Provide structured handover to ED team.<\/span><\/div>\n
<\/div>\n
Key Home Messages for Jordan EMS:<\/div>\n
1. Rapid recognition: severe dyspnea + crackles = treat as AHF\/PE.<\/span><\/div>\n
2. Early CPAP if available.<\/span><\/div>\n
3. SL GTN (0.3\u20130.6 mg, max 3 doses) only if SBP \u2265110.<\/span><\/div>\n
4. Avoid IV nitrates prehospital.<\/span><\/div>\n
5. Loop diuretics not routine; only in known CHF + overload + SBP \u2265100.<\/span><\/div>\n
6. NCPE: oxygen\/supportive only.<\/span><\/div>\n
7. Adjust care for pregnancy, elderly, obesity, COPD\/asthma.<\/span><\/div>\n
8. Always pre-alert hospital for rapid advanced management<\/span><\/div>\n","protected":false},"excerpt":{"rendered":"

\u00a0The Canadian Association of Emergency Physicians (CAEP) Acute Heart Failure Best Practices Checklist (April 2025) \u2013 Comprehensive Practical Review Source: Stiell IG, et al. CAEP Acute Heart Failure Best Practices Checklist. CAEP, April 2025. Introduction CAEP published the Acute Heart Failure (AHF) Best Practices Checklist in April 2025. This ED-focused tool bridges cardiology guidelines (ESC, […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8774","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8774","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=8774"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8774\/revisions"}],"predecessor-version":[{"id":8775,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8774\/revisions\/8775"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8774"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8774"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8774"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}