Acute Pulmonary

Edema, Hypotension,
Shock

Clinical Signs: shock, hypoperfusion, congestive heart

failure, acute pulmonary edema
Most likely problem?

Acute pulmonary edema

Volume problem

First-Line Actions

Administer
Fluids
Blood transfusions
Cause-specific interventions
Consider vasopressors

Oxygen & Intubation as needed

Nitroglycerin SL
Furosemide IV 0.5 to 1 mg/kg
Morphine IV 2 to 4 mg

Pump problem

Bradycardia
(see algorithm)

Rate problem

Tachycardia
(see algorithm)

Blood
pressure?

Next slide

Systolic BP
BP defines 2nd
line of action
(see below)

Systolic BP
<70 mmHg
Signs/symptoms
of shock

Norepinephrine
0.5 30 g/min IV

Systolic BP
70-100 mmHg
Signs/symptoms
of shock

Dopamine
5 15 g/kg per
minute IV

Systolic BP
70-100 mmHg
No Signs/symptoms
of shock
Dobutamine
2 20 g/kg per
minute IV

2nd Acute Pulmonary Edema

Nitroglycerin/nitroprusside if BP >100 mmHg
Dopamine if BP = 70-100 mmHg, signs/symptoms of shock
Dobutamine if BP >100 mmHg, no signs/symptoms of shock

Further diagnostic / therapeutic

considerations
Pulmonary artery catheter
Intra-aortic balloon pump
Angiography for AMI / ischemia
Additional diagnostic studies

Systolic BP
>100 mmHg

Nitroglycerin
10 20 g/min IV
consider
Nitroprusside 0.1
5.0 g/kg per min IV

SELESAI