ACPO Flashcards
Define Acute Cardiogenic Pulmonary Oedema?
Pulmonary oedema due to increased hydrostatic pressure secondary to elevated pulmonary venous pressure
Does Lung compliance decrease or increase in ACPO?
Decreases
How is ACPO best treated?
Oxygenation
Posture
GTN
CPAP
What effect does GTN have in ACPO?
Preload reduction and in higher doeses (>100mcg/min) it also reduces afterload
How does CPAP work in ACPO?
Decreases WOB and stents alveoli during the entire respiratory cycle
What are the contraindications to CPAP?
Hypotension
Pneumothorax
GCS <12
Facial Trauma
Epistaxis
When should IV GTN be considered in ACPO?
All patients who have an inadequate response to sublingual GTN and all patients on CPAP - so it can be titrated to haemodynamic response without interrupting ventilatory support.
How often should blood pressure be checked in ACPO?
Every 3 minutes
What medications are not recommended in the prehospital management of ACPO?
Morphine and IV fluid
SL GTN management in ACPO
-300mcg every 5 mins
-SBP >100mmHg and
-adequate conscious state
When should CPAP be given?
ACPO and SBP >120mmHg
What flow rates can we give CPAP with?
5-10cmH2O via O-two device
OR
8L/min-12L/min respectively
Contraindications for GTN
-no use of PDE-5 inhibitors within:
-24hrs - Sildenafil, Varadenafil or Avanafil
- 48 hours - Tadalafil
-Caution in suspected right ventricular injury
IV GTN infusion dose
-Start at 10mcg/min
-Increase infusion by 5mcg/min every 3-5mins
When should you slow a GTN infusion in ACPO
Rapid BP drop or SBP 120mmHg achieved
When Should you stop a GTN infusion in ACPO
if GCS<12 or SBP < 100mmHg
You have stopped a GTN infusion in ACPO due to a sudden drop in SBP, how should you recommence it?
If SBP stabilises >110mmHg
-at 50% of preceding dose
How do we manage Cardiogenic shock?
Judicious fluid
Vasopressors
Chest pain CPG
