Pulmonary edema: Difference between revisions
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Mechanism | *Mechanism | ||
| Line 24: | Line 18: | ||
###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 | ||
####Titrate IV NTG rapidly upward (200mcg/min or higher) until BP is controlled | ####Titrate IV NTG rapidly upward (200mcg/min or higher) until BP is controlled | ||
##If NTG fails to reduce BP consider nitroprusside | |||
#ACEI | #ACEI | ||
##After pt improves titrate off NTG as enaliprilat or captopril are started | ##After pt improves titrate off NTG as enaliprilat or captopril are started | ||
Revision as of 19:13, 11 May 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
- 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
- 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