Acute Pulmonary Oedema Management

Question 1

Investigations to include in assessment

Answer 1

ABG
BNP 
Troponin if ACS suspected 
ECG
Catheterise - monitor UO 
CXR
ECHO 
Serial weights

Question 2

What is included in the treatment of acute pulmonary oedema

Answer 2

POD MAN + Identify and treat cause

Position - sit up
Oxygen - high-flow then titrate to 94-98%
Diuretic - if fluid overloaded or usually on it - furosemide 40mg IV initially

Morphine 2-4mg IV - if patient distressed
Antiemetic - if nauseous or giving morphine - metoclopramide 10mg IV
Nitrates* - in severe pulmonary oedema
- GTN Infusion if SBP >110
- 2 puffs spray if SBP 90-110

Causes

• Fluid overload - furosemide
• Arrhythmia - treat as per
• Acute aortic / mitral regurgitation - valve replacement
• ACS - PCI
• Tamponade - pericardiocentesis
• Hypertensive crisis - BP management

*nitrates reduce preload so avoid in people with atrial stenosis as they rely on preload to maintain CO

Question 3

What further interventions may be considered in acute pulmonary oedema if required

Answer 3

CPAP - if hypoxaemic despite above interventions

Inotropes +/- intra-aortic balloon pump in ICU if in cardiogenic shock (hypotension + overload)

Question 4

What are the long-term treatments for heart failure

Answer 4

Treat cause where possible

Pharmacological measures

• ACE inhibitor (or ARB)
• B-blocker
• Diuretic if overloaded - furosemide, bumetanide
• Add aldosterone antagonist if uncontrolled with above
• Add ivabradine if in NSR >70bpm despite max Bb use

Non-pharmacological treatments

• Cardiac resynchronisation therapy device - if QRS significantly prolonged
• Implantable cardioverter debrillator - consider if risk of ventricular arrhythmia