Acute Cardiogenic Pulmonary Oedema

UNCONTROLLED WHEN PRINTED

Quick Chart

Introduction

ACPO is usually as a consequence of left sided heart failure. In the acutely decompensated state the hydrostatic flow of fluid from the capillaries to the lung parenchyma is favoured causing oedema. This impairs gas exchange resulting in severe respiratory symptoms.

Clinical Presentation

Exclusion Criteria

Risk Assessment

Do not suction endotracheal tube
Hypoxic aggression / irritability
Carefully titrate fluid to effect
Ensure oxygen is administered, even if the patient is trying to reject it (rejection may be due to hypoxia)

Management

Primary Care

Primary Survey
Reassurance (continuous)
Limit patients exertion as much as is practically possible
Vital Sign Survey (particularly oxygen saturation; note: patient may be hypertensive)
Consider Oxygen
Consider Secondary Survey

Intermediate Care (EMT / Level 2)

Administer GTN (provided GTN is not contraindicated)
Apply cardiac monitor if trained and authorised
If IV inserted by a doctor or Paramedic, set flow rate at 20 drops per minute (TKVO)
Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
Transport Priority 1 if patient time critical, pre-notifying receiving facility

Advanced Care (AP)

Administer Glyceryl Trinitrate (GTN)
Obtain vascular access; administer fluid TKVO
Run 12-lead ECG
Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
Transport Priority 1 if patient time critical, pre-notifying receiving facility

Critical & Extended Care (CCP, PSO)

Additional Information

References

Key Terms & Links

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Directorate

Clinical Services

Responsible Manager

Head of Clinical Services

Published Date

Review Date