MyCpdZw - Protocols Details

ACUTE PULMONARY OEDEMA

Pulmonary edema is a condition caused by excess fluid in the lungs.

Diagnosis

Usually fairly obvious clinically.

Brief but full history, usually easier to obtain from relative/ carertaker

Establish precipitating cause:

· Reduction of therapy,

· Arrhythmias (especially. AF, bradycardias),

· Acute Myocardial Infarction and ischaemia,

· Pulmonary embolism

· Systemic infection,

· Myocarditis, endocarditis, cardiomyopathy, valvular disease (rupture or stenosis),

· High output state (Thyrotoxicosis, anaemia),

· Cardiac depressants (B-blockers), sodium chloride retainers (NSAID’s),

· Alcohol

· Adult Respiratory Distress Syndrome,

· Hypoalbuninaemia,

· Eclampsia

Management

1. ABC’s,

2. Sit patient upright,

3. High-flow oxygen,

4. Continuous monitoring,

5. Aim for saturation of >94%

6. IV access,

7. FBC, U&E’s, LFT’s, Cardiac Enzymes. Consider Thyroid Function Tests

8. EGG,

9. CXR,

10. Reduce pre-load

· GTN 300 mcg (if SBP>100 mmHg),

· GTN patch 25-50 mg,

· Consider GTN infusion especially if associated with Ischaemic pain (GTN 200 mg in 500 mL 5% Dextrose = 400 mcg/Ml. Infuse at 1 Ml/hour and increase to 20 Ml/hour avoiding hypotension).

11. Frusemide 40mg IV (or twice their usual daily dose) Can be repeated after 30 minutes if poor diuresis,

12. Commence CPAP (Continuous Positive Airways Pressure):

· Via tight mask with high gas flow,

· AVOID if Systolic Blood Pressure <100 mmHg,

· Start with -5-10 cm and be guided by response,

13. Cautiously try small doses of Morphine -2.5 mg IV if markedly SOB, associated chest pain or distressed. However, avoid if drowsy, confused or exhausted.

14. Consider in-dwelling catheter,

15. Consider intubation and ventilation (where appropriate) if hypotensive or deteriorating,

16. Consider Ionotropic support

· Dopamine 2-20 mcg/kg/min &

· Dobutamine 2-30 mcg/kg/min.

17. Look for treatable mechanical causes,

18. Admit to appropriate ward/ centre

Recent Protocols

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