Pulmonary edema

Revision as of 23:17, 2 April 2014 by SRafael (talk | contribs) (dosing and alternatives for treatment)

Background

  • 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!

Diagnosis

  • Crackles
  • Respiratory distres

Treatment

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

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

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