Acute cardiogenic pulmonary edema, CPAP

Question 1

What are the indications under the acute cardiogenic pulmonary edema m.d.

Answer 1

Moderate to severe respiratory distress
AND
Suspected acute cardiogenic pulmonary edema

Question 2

What are the conditions for nitroglycerine under the ACPE m.d.

Answer 2

Age ≥ 18 years
HR: 60-159 bpm
SBP: normotension

Question 3

What are the contraindication to nitroglycerin (under the ACPE m.d.)

Answer 3

• Allergy or sensitivity to nitrates
• Phosphodiesterase inhibitor use within the previous 48 hours
• SBP drops by one-third or more of its initial value after nitroglycerin is administered

Question 4

What is the treatment of nitroglycerin (under the ACPE m.d.)

Answer 4

SBP ≥ 100 mmHg to < 140 mmHg
- IV or Hx: YES
- Route: SL
- Dose: 0.3mg or 0.4 mg
- Max single dose: 0.4 mg
- Dosing interval: 5 minutes
- Max # of doses: 6
SBP ≥ 140 mmHg
- IV or Hx: NO
- Route: SL
- Dose: 0.3 or 0.4mg
- Max dosing interval: 0.4 mg
- Dosing interval: 5 minutes
- Max # of doses: 6
SBP ≥ 140 mmHg
- IV or Hx: YES
- Route: SL
- Dose: 0.6 or 0.8 mg
- Max dosing interval: 0.8 mg
- Dosing interval: 5 minutes
- Max # of doses: 6

Question 5

What are signs and symptoms of acute cardiogenic pulmonary edema

Answer 5

• SOB worse when lying down or during exertion
• Dizziness
• Sweating
• Cold skin
• Chest pain
• Blood tinged sputum
• Tachypnea
• Tachycardia
• Hypotension

Question 5

What are the conditions for CPAP (CPAP m.d.)

Answer 5

Age ≥ 18 years
RR: tachypnea
SPB: normotension
SpO2 <90% or accessory muscle use

Question 5

What are the indications for CPAP m.d.

Answer 5

Severe respiratory distress
AND
Signs and/or symptoms of acute pulmonary edema or COPD

Question 6

What are the contraindication to CPAP (CPAP m.d.)

Answer 6

• Asthma exacerbation
• Suspected pneumothorax
• Unprotected or unstable airway
• Major trauma or burns to the head or torso
• Tracheostomy
• Inability to sit upright
• Unable to cooperate

Question 7

What is the treatment of CPAP (CPAP m.d.)

Answer 7

Initial setting: 5 cm H2O
Titration increment: 2.5 cm H2O
Titration interval: 5 minutes
Max setting: 15 cm H2O
(or equivalent flow rate of device as per RBHP direction)

Question 8

What is the treatment to consider increasing FiO2 (if available) (CPAP m.d.)

Answer 8

Initial FiO2: 50-100%
FiO2 increment: SpO2 < 92% treatment and/or 10 cm H2O pressure or equivalent flow rate of device as per RBHP direction
Max FiO2: 100%

Question 9

Why is it important to monitor vitals during CPAP

Answer 9

The positive pressure in the thorax may impede ventricular filling, resulting in decreased preload. Patient should be continuously monitored for signs of hypoperfusion

Question 10

Give examples of accessory muscle use

Answer 10

• contraction of sternocleidomastoid and scalene muscle
• Tracheal tugging
• Belly breathing

Question 11

What is tachypnea

Answer 11

RR ≥ 28 breaths/min

Question 12

Can we give a fluid bolus to a pt with acute cardiogenic pulmonary edema after the admission of nitro. Why?

Answer 12

• Yes
• If administration of nitro results in hypotension, a fluid bolus is permitted despite the presence of crackles.
• Once the pt is normotensive, discontinue the bolus and withhold further doses of nitroglycerin.