ACPO

Question 1

what is the most common cause of CPO

Answer 1

LSHF

Question 2

what happens in left sided heart failure that leads to CPO

Answer 2

LV becomes unhealthy and it can’t pump effectively, blood backs up in the pulmonary veins and capillaries

increased pulmonary pressure leadings to fluid from the interstitum pushing into the lungs

Question 3

why dose severe HTN lead to CPO

Answer 3

LV cannot overcome the force required due to high after load

Question 4

what is heart failure

Answer 4

inability of the heart to pump blood/ supply enough blood

Question 5

what are the two types of heart failure

Answer 5

systolic were the ventricles can’t pump hard enough during systole

and diastolic, where not enough blood fills into the ventricles during diastole

Question 6

how dose heart failure lead to arrhythmia

Answer 6

muscle wall becomes thins or thickens

heart cell irritation or ishcemia

arrhythmia

Question 7

guidelines treatment of CPO

Answer 7

Acquire a 12 lead ECG.

Administer 0.8 mg of GTN SL.
Continue to administer 0.8 mg GTN SL every five minutes as above if the patient is not improving. Increase the dosing interval to ten minutes if caution is required.

Apply CPAP if the patient has moderate to severe respiratory distress that is not rapidly improving (see the ‘CPAP’ section). If backup for CPAP is unavailable or delayed, apply PEEP.

Commence a GTN infusion IV if the patient is not rapidly improving.

Fentanyl in 10-20 mcg doses IV or morphine in 1-2 mg doses IV may be administered every five minutes as required for severe anxiety

Question 8

role of GTN in CPO

Answer 8

reduces preload and after load, off loading some strain from the heart, thus reducing the volume and ejection force required for the heart to pump

Question 9

role of CPAP in CPO

Answer 9

decreased WOB and increased cardiac output by provoking a constant trend of positive pressure treating alveolar collapse

Question 10

what is negative pressure pulmonary oedema

Answer 10

during any form of asphyxiation, negative pressure can develop in the thoracic cavity as a result of inspiratory effort against a closed airway

Question 11

common mistakes with CPO

Answer 11

mistaking COPD for CPO

pneumonia for CPO

fail to identify route cause e.g. STEMI

Question 12

how to treat negative pressure pulmonary oedema

Answer 12

do not go down CPO pathway, no CPAP or GTN, treat hypoxia

Question 13

how to treat a CPO who is on a long acting vasodilator

Answer 13

reduce GTN dose to 0.4 mg and increase dose interval to 10 mins, prioritise CPAP

Question 14

presentation of severe/ life threatning ACPO

Answer 14

Distressed, anxious, fighting to breathe, exhausted, catatonic

Words only or unable to speak

fine crackles - full field, with possible wheeze Marked chest movement with accessory muscle use, intercostal retraction+/- tracheal tugging

alt LOC

tacky ++ or Brady late sign

Question 15

moderate CPO presentation

Answer 15

distressed

speaking 2-3 words

crackles at bases/ mid zone

decreased SP02

accessory use

pale and diaphoretic

Question 16

name some common classes of antihypertensives

Answer 16

Direct-acting vasodilators (hydralazine, minoxidil, nitrates, nitroprusside)

Calcium channel blockers (verapamil, diltiazem, nifedipine, amlodipine)

An antagonist of the renin-angiotensin-aldosterone system (angiotensin receptor blockers, angiotensin-converting-enzyme inhibitors)

Beta-2 receptor agonist (salbutamol, terbutaline)