ACPO

Question 1

Define Acute Cardiogenic Pulmonary Odema

Answer 1

Fluid on the lungs caused by increased capillary Hydrostatic pressure, secondary to elevated pulmonary venous pressure.

Question 2

How does CCF cause APO

LHF

What changes for ACPO to occur

Answer 2

Congestive Cardiac failure LHF is where the left heart fails to pump forward. Can by hypertrophic (fat) or dilated, Thin and weak.
Blood backs up through the lungs.

Changes in hydrostatic pressure occur as the right heart increases pulmonary capillary pressure, so fluid moves to alveolar space.

Fluid shift are from changes in pressure, not increases in fluid.

Question 3

How do we treat ACPO

5

Answer 3

Basic care and 12 lead (Continuous)
Clinical support
Oxygen
Posture - Laying down makes worse
GTN - no PDE-5 inhibitors or preload dependent rhythms

Question 4

GTN administration in ACPO

Answer 4

GTN - 400microg p spray following allergy checks

SBP 100mmHg

BP monitoring every 3 minutes

Question 5

Explain RHF and APO

Answer 5

Right ventricle dysfunction leads to peripheral odema. Blood backs up systemically and increases the pressure that the left heart has to pump against. With nowhere to go, blood backs up into the pulmonary circulation

Question 6

APO and ICP

2

Answer 6

1. GTN infusion can be given by ICP if SL GTN doesnt work

2. CPAP for ICP

Question 7

Precautions in APO

3

Answer 7

Preload depentent Rhythms
RV injury
No opiates.

Question 8

APO and
AF

RV injury (RHF)

Answer 8

AF.
very little to no atrial kick, therefore LV relies on preload. GTN vasodiltes and reduces systemic pressure - reduces preload and this can be bad.

RV injury.
Signs of inferior ischemia or injury - If GTN given and preload drops, then RV cant supply enough blood. HR increases to compensate (decreases aortic stretch) RV unable to keep up - Makes things worse.

Question 9

How does CPAP help APO

Answer 9

CPAP decreases the WOB and splints open the alveoli during the entire resp cycle leading to improved gas exchange.

Question 10

how does GTN work inAPO

Answer 10

GTN is a vasodilator. It causes peripheral vasodilation and increases coronary blood flow.

• GTN reduces systemic vascular resistance (opens the bucket) so more blood flows forward from the heart.
• Reduces the volume of blood in the pulmonary circulation.
• Reduces pulmonary venous hypertension.
• Reduces pulmonary capillary hydrostatic pressure.