RRAPID: Acute Pulmonary Oedema

Question 1

Causes? (5)

Answer 1

Left ventricular failure (high-output heart failure)
Heart disease (e.g. valve, ischeamia, arrhythmia, myopathy, tamponade)
Fluid overload
Hypoalbuminaemia - liver failure, sepsis
Acute PE
Acute/chronic airway obstuction

Question 2

Symptoms? (9)

Answer 2

Dyspnoea 
Orthopnoea
Pink frothy sputum
Inspiratory crackles
Wheeze 
Pale, sweaty, distressed 
Oliguria 
Increased JVP
Triple/gallop rhythm (extra heart sound)
Pulmonary congestions +/- ACS

Question 3

Response (Airway) ?

Answer 3

Sit patient up

O2 15L/min via a reservoir mask

Question 4

Response (Breathing)?

Answer 4

CXR

ABG

Question 5

What would be the CXR findings? (4)

Answer 5

Cardiomegaly
“Bats wings” - fluffy bilateral shadowing with peripheral sparing
Kerley B lines
Pleural effusions

Question 6

Response (Circulation)?

Answer 6

Monitor BP
ECG
Echo
IV access (fluid if required) 
Bloods: FBC, U&E's, LFT's, glucose, CRP, albumin, cardiac enzymes
Treat any arrhythmias.

Question 7

Medication Mx? (4)

Answer 7

Diamorphine 2.5 mg IV (slow)

Furosemide 40-80 mg IV (slow)

GTN (2 sprays of 500 mcg sublingual if BP > 90mmHg systolic)

GTN infusion 50mg in 50ml 0.9% NaCl IV at 2ml/hr titrating up to 20ml/hr, maintaing BP >90mmHg systolic (target: 110mmHG)

Question 8

When should you be cautious about giving diamorphine?

Answer 8

COPD & liver failure - vasodilation

Question 9

Contraindication of GTN?

Answer 9

Aortic stenosis

Question 10

What NIV can be considered?

Answer 10

CPAP

Question 11

What can be given of wheeze is a predominant feature?

Answer 11

Salbutamol