Pulmonary edema: Difference between revisions
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###Loading dose: 400mcg/min x 2min | ###Loading dose: 400mcg/min x 2min | ||
####With 100mg/250mL NTG in D5W, draw up 2mL (400mcg/mL), push over 2 min, equiv to above | ####With 100mg/250mL NTG in D5W, draw up 2mL (400mcg/mL), push over 2 min, equiv to above | ||
#####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 | ####Then drop to 100mcg/min and titrate up as needed | ||
###Repeated sublingual 0.4 mg q1min until IV NTG (0.5-0.7 mcg/kg/min) is started | ###Repeated sublingual 0.4 mg q1min until IV NTG (0.5-0.7 mcg/kg/min) is started | ||
Revision as of 23:46, 13 September 2011
Background
- Mechanism
- Failing heart > pulm edema > stress response > incr afterload
- Incr afterload > incr pulm edema
- Failing heart > pulm edema > stress response > incr afterload
- Pts often intravascularly depleted; avoid diuretics!
Diagnosis
- Crackles
- Respiratory distres
Treatment
- CPAP/BiPAP with PEEP 6-8; titrate up to PEEP of 10-12
- Nitroglycerin
- Dosing Options
- Loading dose: 400mcg/min x 2min
- With 100mg/250mL NTG in D5W, draw up 2mL (400mcg/mL), push over 2 min, equiv to above
- 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
- With 100mg/250mL NTG in D5W, draw up 2mL (400mcg/mL), push over 2 min, equiv to above
- 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
- Loading dose: 400mcg/min x 2min
- If NTG fails to reduce BP consider nitroprusside
- Dosing Options
- ACEI
- After pt improves titrate off NTG as enaliprilat or captopril are started
See Also
Source
Tintinalli
EMCrit Podcast 1