Pulmonary edema: Difference between revisions

Revision as of 17:23, 26 March 2014

Cardiogenic vs Non-Cardiogenic (ARDS/Altitude/Neurogenic)
Mechanism of Cardiogenic
- Failing heart > pulm edema > stress response > incr afterload
  - Incr afterload > incr pulm edema
Pts often intravascularly depleted; avoid diuretics!

CPAP/BiPAP with PEEP 6-8; titrate up to PEEP of 10-12
Nitroglycerin
1. Dosing Options
  1. Sublingual 0.4 mg q5min
  2. Intravenous: 0.1mcg/kg/min - 5mcg/kg/min (

Generally start IV Nitroglycerin 50mcg/min and titrate rapidly (150mcg/min or higher)to symptom relief

1. If NTG fails to reduce BP consider nitroprusside
ACEI
1. After pt improves titrate off NTG as enaliprilat or captopril are started

Tintinalli

EMCrit Podcast 1

Authors:

@@ Line 14: / Line 14: @@
 #Nitroglycerin
 ##Dosing Options
-###Loading dose: 400mcg/min x 2min
+###Sublingual 0.4 mg q5min
-####With 100mg/250mL NTG in D5W, draw up 2mL (400mcg/mL), push over 2 min, equiv to above
+###Intravenous: 0.1mcg/kg/min - 5mcg/kg/min (
-#####Helpful is RN unwilling to run at 400 mcg/min or delay in setting up drip
-####Then drop to 100mcg/min and titrate up as needed
+Generally start IV Nitroglycerin 50mcg/min and titrate rapidly (150mcg/min or higher)to symptom relief
-###Repeated sublingual 0.4 mg q1min until IV NTG (0.5-0.7 mcg/kg/min) is started
-####Titrate IV NTG rapidly upward (200mcg/min or higher) until BP is controlled
 ##If NTG fails to reduce BP consider nitroprusside
 #ACEI