Pulmonary edema: Difference between revisions
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##Dosing Options | ##Dosing Options | ||
###Sublingual 0.4 mg q5min | ###Sublingual 0.4 mg q5min | ||
###Nitropaste (better bioavailability than oral Nitroglycerin) | |||
###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 or ACE-inhibitiors | *If NTG fails to reduce BP consider nitroprusside (reduces both preload and afterload) or ACE-inhibitiors (preload reducer) | ||
*After pt improves titrate down NTG as enaliprilat or captopril are started | *After pt improves titrate down NTG as enaliprilat (0.625 - 1.25mg IV) or captopril are started | ||
==See Also== | ==See Also== | ||
Revision as of 23:17, 2 April 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
- Nitropaste (better bioavailability than oral Nitroglycerin)
- 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 (reduces both preload and afterload) or ACE-inhibitiors (preload reducer)
- After pt improves titrate down NTG as enaliprilat (0.625 - 1.25mg IV) or captopril are started
See Also
Source
Tintinalli
EMCrit Podcast 1