Pulmonary edema

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. Intravenous: 0.1mcg/kg/min - 5mcg/kg/min (

Generally start IV Nitroglycerin 50mcg/min and titrate rapidly (150mcg/min or higher)to symptom relief

1. 1. If NTG fails to reduce BP consider nitroprusside
2. ACEI
   1. After pt improves titrate off NTG as enaliprilat or captopril are started

See Also

• Congestive Heart Failure (CHF)
• Acute Respiratory Distress Syndrome

Source

Tintinalli

EMCrit Podcast 1