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Acute pulmonary oedema management

Include in assessment 

 

  • ECG β€“ the acute LVF may be caused by ACS or an arrhythmia
  • CXR
  • Echocardiogram
  • Catheterise and implement strict fluid balance charting
  • Serial weights
  • B-type natriuretic peptide
  • Troponin if ACS suspected
  • ABG

Initial ABCDE approach

Follow usual ABCDE approach if critically ill.

Treatment – POND

  • Position (sit up)
  • Oxygen (high-flow initially; titrate to keep oxygen saturations 92-96%, consider CPAP on CCU or HDU if required)
  • Nitrates in severe pulmonary oedema (GTN infusion if SBP >110, or 2 puffs GTN spray if SBP 90-110) 
  • Diuretic if fluid overloaded or usually on it (e.g. furosemide 40mg IV initially) 
  • +treat cause

Identify and treat cause

  • ACS β†’ see notes on ACS
  • Arrhythmia β†’ see notes on arrhythmias
  • Tamponade β†’ pericardiocentesis
  • Acute aortic/mitral regurgitation β†’ valve replacement
  • Hypertensive crisis β†’ BP management
  • Fluid overload β†’ regular furosemide

Further interventions if required

  • CPAP if hypoxaemic despite above interventions
  • Inotropes Β± intra-aortic balloon pump in ICU if in cardiogenic shock (hypotension + overload)

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