Podcast 723: Nitro Drip in Flash Pulmonary Edema

Podcast 723: Nitro Drip in Flash Pulmonary Edema

Contributor: Alec Coston, MD

Educational Pearls:

  • Flash pulmonary edema or Sympathetic Crash Acute Pulmonary Edema (SCAPE) is a severe illness that requires aggressive treatment
  • Often in patients with heart failure and a sympathetic surge increasing heart rate, decreased diastolic filling, increased preload, and increased afterload causing pulmonary edema
  • Clinical diagnosis: acute onset diaphoresis and respiratory distress, hypoxia and tachypnea on exam
  • Bedside lung ultrasound will demonstrate B-lines, indicative of pulmonary edema
  • Treatment is nitroglycerin and BiPAP
  • Nitroglycerin drip can be started at 80 micrograms/minute, which is similar to the dose delivered by sublingual nitroglycerin

References

Stemple K, DeWitt KM, Porter BA, Sheeser M, Blohm E, Bisanzo M. High-dose nitroglycerin infusion for the management of sympathetic crashing acute pulmonary edema (SCAPE): A case series. Am J Emerg Med. 2021;44:262-266. doi:10.1016/j.ajem.2020.03.062

Agrawal N, Kumar A, Aggarwal P, Jamshed N. Sympathetic crashing acute pulmonary edema. Indian J Crit Care Med. 2016;20(12):719-723. doi:10.4103/0972-5229.195710

Wilson SS, Kwiatkowski GM, Millis SR, Purakal JD, Mahajan AP, Levy PD. Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. Am J Emerg Med. 2017;35(1):126-131. doi:10.1016/j.ajem.2016.10.038

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.

Donate to EMM today!

Jaksot(1144)

Episode 950: Ultrasound Pulse Check During Cardiac Arrest

Episode 950: Ultrasound Pulse Check During Cardiac Arrest

Contributor: Aaron Lessen, MD Educational Pearls: Point-of-care ultrasound (POCUS) is used to assess cardiac activity during cardiac arrest and can identify potential reversible causes such as peric...

31 Maalis 20252min

Episode 949: Hoover's Sign

Episode 949: Hoover's Sign

Contributor: Travis Barlock, MD Educational Pearls: What is Hoover's sign used to identify? This physical exam maneuver differentiates between organic vs. functional (previously known as psychogenic...

24 Maalis 20251min

Episode 948: CYP Inducers and Inhibitors

Episode 948: CYP Inducers and Inhibitors

Contributor: Jorge Chalit-Hernandez, OMS3 Educational Pearls: CYP enzymes are responsible for the metabolism of many medications, drugs, and other substances CYP3A4 is responsible for the majorit...

17 Maalis 20253min

Episode 947: Hypercapnia

Episode 947: Hypercapnia

Educational Pearls: Physiologic stimulation of ventilation occurs through changes in levels of: Arterial carbon dioxide (PaCO2) Arterial oxygen (PaO2) Hypercapnia is an elevated level of CO2...

10 Maalis 20253min

Episode 946: Time to Defibrillation

Episode 946: Time to Defibrillation

Contributor: Aaron Lessen, MD Educational Pearls: Quick background info Cardiac arrest is when the heart stops pumping blood for any reason. This is different from a heart attack in which the heart ...

3 Maalis 20252min

Episode 945: Ketorolac vs. Ibuprofen

Episode 945: Ketorolac vs. Ibuprofen

Contributor: Ricky Dhaliwal, MD Educational Pearls:  Ketorolac and ibuprofen are NSAIDs with equivalent efficacy for pain in the emergency department Oral ibuprofen provides the same relief as in...

24 Helmi 20253min

Episode 944: Colchicine Overdose

Episode 944: Colchicine Overdose

Contributor: Aaron Lessen, MD Educational Pearls: Colchicine is most commonly used for the prevention and treatment of gout There is research investigating the anti-inflammatory and cardioprotect...

17 Helmi 20253min

Episode 943: Portal Vein Thrombosis

Episode 943: Portal Vein Thrombosis

Contributor: Travis Barlock, MD Educational Pearls: What is Portal Vein Thrombosis? The formation of a blood clot within the portal vein, which carries blood from the gastrointestinal tract, pancrea...

10 Helmi 20252min

Suosittua kategoriassa Tiede

rss-mita-tulisi-tietaa
tiedekulma-podcast
rss-poliisin-mieli
docemilia
rss-duodecim-lehti
utelias-mieli
radio-antro
filocast-filosofian-perusteet
rss-laakaripodi
rss-lihavuudesta-podcast
rss-sosiopodi
ihanat-ipanat
sotataidon-ytimessa
mielipaivakirja
rss-radplus
rss-opeklubi