Acute cardiogenic pulmonary oedema

Diagnosis: The flash cardiogenic pulmonary oedema — the sudden severe breathlessness, the frothy pink sputum, the hypoxia (the 84 per cent), the hypertensive crisis (the 200 over 115), and the bilateral crackles with the raised JVP.^[1]

Management:

1. The ABCDE, the sit upright.
2. The high-flow oxygen and the CPAP early — the CPAP reduces the preload and the afterload, splints alveoli, improves oxygenation (the Cochrane confirms the benefit).
3. The IV GTN infusion — the venodilatation and the arteriolar dilatation, the reduced preload and the afterload, the titrated to the controlled blood-pressure reduction (target gradual fall, not the precipitous).
4. The IV furosemide — the diuresis and the venodilation.
5. The treat-the-cause — the ECG and the troponin (the ischaemia and the MI), the echo (the function, the valve), the treat-the-trigger (the PCI, the rate or the rhythm control).
6. The monitoring — the continuous oxygen saturation, the blood pressure, the respiratory rate, the urine output, the blood gas.
7. The disposition — the high-dependency or the intensive care.

The caution: The morphine is the cautious (the respiratory depression, the hypotension). The vasodilator and the diuretic are the titrated to the response and the blood pressure.^[1]