Pulmonary edema: Difference between revisions
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##Dosing Options | ##Dosing Options | ||
###Sublingual 0.4 mg q5min | ###Sublingual 0.4 mg q5min | ||
###Intravenous: 0.1mcg/kg/min - 5mcg/kg/min | ###Intravenous: 0.1mcg/kg/min - 5mcg/kg/min | ||
Generally start IV Nitroglycerin 50mcg/min and titrate rapidly (150mcg/min or higher)to symptom relief | ''Generally start IV Nitroglycerin 50mcg/min and titrate rapidly (150mcg/min or higher)to symptom relief'' | ||
##If NTG fails to reduce BP consider nitroprusside | ##If NTG fails to reduce BP consider nitroprusside or ACE-inhibitiors | ||
##After pt improves titrate down NTG as enaliprilat or captopril are started | |||
##After pt improves titrate | |||
==See Also== | ==See Also== | ||
Revision as of 17:25, 26 March 2014
Background
- Cardiogenic vs Non-Cardiogenic (ARDS/Altitude/Neurogenic)
- Mechanism of Cardiogenic
- 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
- Sublingual 0.4 mg q5min
- Intravenous: 0.1mcg/kg/min - 5mcg/kg/min
- Dosing Options
Generally start IV Nitroglycerin 50mcg/min and titrate rapidly (150mcg/min or higher)to symptom relief
- If NTG fails to reduce BP consider nitroprusside or ACE-inhibitiors
- After pt improves titrate down NTG as enaliprilat or captopril are started
See Also
Source
Tintinalli
EMCrit Podcast 1