Pulmonary Edema

Often our tepid dosing of nitroglycerine is to blame for treatment failure - Rory Spiegel MD

Pulmonary Edema
Pulmonary Edema

image by: Hellerhoff

HWN Suggests

Shift Away from Loop Diuretics for Pulmonary Edema

Improving upon the classic LMNOP approach (Lasix, morphine, nitrates, oxygen, PPV) to congestive heart failure, innovations in modern cardiogenic pulmonary edema management revolve around a growing understanding of the disparate fluid states that may exist between the systemic and cardiopulmonary circulations, that patients with acute pulmonary edema may still be euvolemic or hypovolemic with long-term diuretic use. This two-buckets theory has prompted a focus on preload reduction rather than diuresis, and care has shifted away from rapid administration of loop diuretics and now prioritizes the use of high-dose nitroglycerin and noninvasive ventilation.

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 Shift Away from Loop Diuretics for Pulmonary Edema

Managing cardiogenic pulmonary edema in the emergency department is a complex and critical call of the emergency physician. These patients often arrive in profound distress, requiring immediate bedside response and comprehensive intervention.

Core EM

APE, CHF exacerbation and cardiogenic shock are different diseases and must be approached and treated differently. The lungs in a patient with APE are like an overflowing bathtub. We have to simultaneously stop the inflow of blood by turning off the tap (preload reduction) and increase outflow by unclogging the drain (afterload reduction).

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