Episode 71.0 – Acute Pulmonary Edema – 22:36. Published November 7, 2016. Link is to podcast and show notes:
This week we [Core EM] feature a lecture from Anand Swaminathan at our weekly conference on the ED management of acute pulmonary edema.
Listen to the podcast above and then review the blog post Core EM: Acute Pulmonary Edema by Dr. Swaminathan published September 2, 2015. The blog post is essentially the detailed notes of the podcast.
What follows are my notes on the podcast – again, for detailed notes from the speaker see Core EM: Acute Pulmonary Edema.
The best way to diagnose acute pulmonary edema and differentiate it from the other causes of acute dyspnea is with bedside ultrasound using the *Blue Protocol (See below) and clinical gestalt.
Chest x-ray isn’t that helpful.
The key to helping the acute pulmonary edema patient is to immediately (within the first 10 minutes) initiate non-invasive positive pressure ventilation and sublingual nitroglycerin (followed by IV nitroglycerin if the patient tolerated the sublingual [SL] nitroglycerin [that is – didn’t drop his pressure with the SL nitroglycerin].
Morphine doesn’t help and furosemide doesn’t help.
The most common cause of acute pulmonary edema is acute coronary syndrome (ekg and troponin). Another cause of acute pulmonary edema is acute valvular insufficiency. Both of these etiologies should be investigated with bedside ultrasound (use color flow to diagnose acute valvular insufficiency).
Also be sure to listen to and review the podcast notes of EMCrit: Podcast 1 – Sympathetic Crashing Acute Pulmonary Edema and the other resources Dr. S provides below.
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*Lung Ultrasound Signs From “BLUE-Protocol and FALLS-Protocol: Two Applications of Lung Ultrasound in the Critically Ill”
Posted on September 9, 2016 by Tom Wade MD.
This post covers the ten lung ultrasound signs that you need to master to diagnose the causes of acute respiratory failure with lung point of care ultrasound.
*Lung Ultrasound Profiles From the BLUE Protocol – “BLUE-Protocol and FALLS-Protocol: Two Applications of Lung Ultrasound in the Critically Ill”
Posted on September 13, 2016 by Tom Wade MD.
This post discusses the [Eight] Lung Ultrasound Profiles of the BLUE protocol [decision tree] from BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Chest. 2015 Jun;147(6):1659-70. doi: 10.1378/chest.14-1313.
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Resources From Podcast Episode 71 Show Notes
Core EM: Acute Pulmonary Edema
EMCrit: Podcast 1 – Sympathetic Crashing Acute Pulmonary Edema
REBEL EM: Morphine Kills in Acute Decompensated Heart Failure
emDocs: Furosemide in the Treatment of Acute Pulmonary Edema
