Severe Pulmonary Oedema

Question 1

What is the management of severe pulmonary oedema secondary to acute heart failure?

Answer 1

Sit patient upright
High flow oxygen
IV access, ECG, treat arrhythmias
Diamorphine
Furosemide 40-80mg IV slowly
GTN spray 

If systolic BP >100, start a nitrate infusion

Question 2

If the patient is worsening after initial management, what can you do?

Answer 2

Further dose of furosemide 40-80mg

Consider CPAP

Question 3

If a patient is stable and improving following severe pulmonary oedema, what is the management?

Answer 3

Repeat CXR
Change IV to PO furosemide or bumetanide
ACE-i if LVEF <50%

Question 4

What are the symptoms and signs of pulmonary oedema?

Answer 4

Symptoms: SOB, orthopnoea, pink frothy sputum

Signs: distressed, pale, sweaty, tachycardic, increased JVP, wheeze

Question 5

What is the management of bradycardia if there are no adverse signs?

Answer 5

Risk of asystole (Mobitz II AV block/complete heart block)?
No = continue observation
Yes = atropine 500mcg IV every 3-5mins
adrenaline 2-10mcg/min IVI

Question 6

What is the management of bradycardia if there are adverse signs?

Answer 6

atropine 500mcg IVI 
if there is no satisfactory response,
repeat atrophine 500mcg every 3-5 mins
transcutaneous pacing
possible adrenaline 2-10mcg/min