Pulmonary Oedema CPG A0406

Flashcards about Pulmonary Oedema

Cardiogenic APO

Symptomatic pulmonary oedema,

Secondary to LVF or CCF.

Why use Nitrates

Treat underlying cause of cardiogenic APO

Should be administered to all patients presenting in symptomatic cardiogenic APO unless contraindicated.

Why use CPAP

Appropriate treatment for respiratory failure associated with APO

While underlying cause is addressed.

When to use Furosemide

May be considered in normotensive patients, or when hypertension has been corrected with nitrates.

Not a first line treatment in hypertensive patients with a sympathetically driven APO

Non-cardiac APO causes

Smoke/toxic gas inhalation,

Near drowning (aspiration) & anaphylaxis; treated with supplemental oxygen and assisted ventilation where indicated.

Contraindications to CPAP

Inability to manage own airway,

Altered conscious state,

Active vomiting,

Excessive secretions,

Hypoventilation,

Untreated tension pneumothorax,

Hemodynamic instability,

Severe hypotension.

Indications for Bi-PAP or CPAP removal

Ineffective treatment (cardiac/respiratory arrest, mask intolerance, decreasing respiratory effort, nil improvement after 1 hour),

Deteriorating vital signs, or risk to patient (loss of airway control, copious secretions, active vomiting, paramedic judgment of clinical deterioration).

APO treatment

GTN patch 50mg (remove <100mmHg)

GTN 300mcg / 600mcg S/L - 5/60 titrated to pain / side effects

No improvement

CPAP 10cmH2O (BiPAP 10/5 &1.0 for Z) / consider furosemide 20-40mg IV (max 100mg)