Pulmonary Oedema (Adult)

Not Short of Breath			Short of Breath
BLS If deteriorates, treat as for Short of Breath			Basal/Midzone Crackles           Previous Nitrates   No Previous Nitrates BP >110: GTN 600mcg S/L/Buccal   BP >110: GTN 300mcg S/L/Buccal If symptoms continue and BP remains >110: - Repeat GTN 600mcg S/L/ Buccal 5 Minutely   If symptoms continue and BP remains >110: - Repeat GTN 300mcg S/L/ Buccal 5 Minutely           BP >90: GTN Patch 10mg (0.4mg/hr) upper torso/arm - If BP falls <90, remove patch     Frusemide 20 - 40mg IV     No improvement or deteriorates Treat as for Full Field Crackles			Full Field Crackles           Previous Nitrates   No Previous Nitrates BP >110: GTN 600mcg S/L/Buccal   BP >110: GTN 300mcg S/L/Buccal If symptoms continue and BP remains >110: - Repeat GTN 600mcg S/L/ Buccal 5 Minutely   If symptoms continue and BP remains >110: - Repeat GTN 300mcg S/L/ Buccal 5 Minutely           BP >90: - GTN Patch 10mg (0.4mg/hr) upper torso/arm - If BP falls <90, remove patch     Frusemide 40mg IV or Pt’s daily dose IV as a single dose (max. 100mg) If alert and anxious - Consider Morphine 1–2mg IV     No improvement or deteriorates Suction if required - Provide assisted ventilation with PEEP CPAP if available Intubate if necessary as per Intubation

Special Notes

This Guideline is primarily directed at cardiogenic pulmonary oedema, secondary to LVF or CCF. - Other medical causes of pulmonary oedema should not be treated under this Guideline.   - Non-medical causes include: smoke inhalation/toxic gases, near drowning (aspiration) and anaphylaxis. Pulmonary oedema is likely a result of altered permeability.   - These causes should be treated with oxygen therapy and assisted ventilations and do not require nitrates.

General Care

Manage chest pain as per Acute Coronary Syndrome.

Frusemide should be used cautiously in the hypotensive Pt.

Pts with pulmonary oedema presenting with a wheeze should only be managed as per Asthma if a history of bronchospasm can be confirmed.

Avoid the use of Salbutamol in the setting of pulmonary oedema where possible.

Remove GTN patch if BP decreases <90.