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 or ACE-inhibitiors
   2. After pt improves titrate down NTG as enaliprilat or captopril are started

See Also

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

Source

Tintinalli

EMCrit Podcast 1