You haven’t truly earned your place on the wards until you’ve seen a CHF patient rolled in gasping like they just ran a marathon — except they only made it from the bathroom to the bed. 💨💦
At Sheikh Khalifa Hospital, managing congestive heart failure is almost a weekly drill — especially post-rainy season when patients from places like Nok Kundi (Balochistan) arrive after traveling 12 hours on bumpy roads, decompensated and dangerously fluid-overloaded.
In such moments, your brain needs one thing: UNLOAD FAST 🧠⚡
Because CHF management isn’t a guessing game — it’s a protocol you execute like a pit crew at a Formula 1 race.
🧠 Mnemonic: “UNLOAD FAST”
| Letter | Treatment | Clinical Rationale |
|---|---|---|
| U | Upright Position | Improves venous return, reduces pulmonary congestion. Let gravity do its job. 🪑 |
| N | Nitrates | Venodilators ↓ preload; relieve dyspnea. But watch that BP. 💉 |
| L | Lasix (Furosemide) | Diuretic of choice to get that fluid out — fast and furious. 💦 |
| O | Oxygen | For obvious hypoxia. Bonus: nasal prongs make you look busy. 😷 |
| A | ACE Inhibitors | Reduce afterload and remodeling. Just don’t start them if creatinine is acting shady. 🧪 |
| D | Digoxin | Slows AV conduction, improves contractility — but handle like it’s radioactive. ☢️ |
| F | Fluids (restrict) | CHF and IV NS are enemies. Limit to 1–1.5L/day max. 🚫💧 |
| A | Afterload (reduce) | ACEi/ARBs or hydralazine — make it easier for the heart to push blood out. ⬇️🫀 |
| S | Sodium restriction | No more Biryani Fridays. Salt = water retention = decompensation. 🧂🙅♂️ |
| T | Tests: Dig level, ABGs, K⁺ | Check electrolytes, especially K⁺ & Mg²⁺. Dig toxicity is one bad day away. 🔬🧫 |
🩺 Clinical Encounter from Quetta
Just last month, we had a 70-year-old gentleman from Mashkhel brought in by his son. “Abbu ki saans phool rahi hai” — classic signs of CHF. Orthopnea, 2+ leg edema, BNP high enough to make Dr. Imran Baloch nod in approval.
I remember Dr. Basit Khan saying, “Let’s UNLOAD FAST.”
By the time we got to “F”, the patient was upright, Lasix had kicked in, and oxygen sat had jumped from 84% to 95%. Simple steps. Big difference.
Happy learning, folks! 🙂
Authored by:
Dr. Aurangzaib Qambrani
MBBS | PLAB | MRCP (UK)
Sheikh Khalifa Bin Zayed Hospital, Quetta
