Immediate Management

Management of the acutely ill patient with PH should include careful evaluation for secondary causes of decompensation (such as a low-grade line infection or pulmonary thromboembolism).

The management approach can be broadly divided into two stages: immediate ED management and subsequent or specialist management. Immediate ED management options are presented below.

Problem Intervension(s) required
Hypoxaemia Supplemental oxygen
  • Beta blockers
  • Calcium channel blockers
  • Digoxin
Volume overload
  • Diuretics
  • Inotropes or vasopressors
Acute right heart failure
  • Spironolactone
  • Digoxin
  • Search for underlying precipitant
Cardiac arrest Advanced life support resuscitation while searching for underlying precipitant
Technical intravenous catheter and pump problems Prompt restoration of intravenous therapy
Catheter-related infection
  • Prompt blood cultures
  • Empiric initiation of appropriate antibiotic therapy
Bleeding in warfarinised PH patients
  • Avoidance of unnecessary punctures (e.g. arterial blood gas sampling)
  • Correct INR
  • Search and correct underlying cause (e.g. drug interaction)