First line Treatment of acute pulmonary edema?(LQ)
Treatment of acute pulmonary edema
1. Strict bed rest. (Raised head end of the bed)
2. Sublingual nitroglycerin (0.4 mg x 3 every 5 min) is first-line therapy for acute cardiogenic pulmonary edema. (Ref. Hari-18th ed., Pg-2237)
3. Metolazone and IV frusemide
4. IV morphine (dose = 2 to 3 mg iv.)
5. DVT prophylaxis: eg heparin 5000u/8h sc.
6. Inotrope may be needed.
7. Finally, a heart transplant.
Unusual Types of Pulmonary Edema: (Ref. Hari-18th ed., Pg 2238)
1. Reexpansion pulmonary edema
a. It can develop after removal of air or fluid that has been in the pleural space for some time.
b. These patients may develop hypotension or oliguria resulting from rapid fluid shifts into the lung.
c. Diuretics and preload reduction are contraindicated,
d. Intravascular volume repletion often is needed while supporting oxygenation and gas exchange.
2. High-altitude pulmonary edema
a. It often can be prevented by use of dexamethasone, calcium channel-blocking drugs, or long-acting inhaled 2-adrenergic agonists.
b. Treatment includes descent from altitude, bed rest, oxygen, and, if feasible, inhaled nitric oxide; nifedipine may also be effective.
3. Pulmonary edema resulting from upper airway obstruction,
a. It recognition of the obstructing cause is key
b. Treatment is to relieve or bypass the obstruction.