Acute Pulmonary Oedema

Clinical features

• Extreme breathlessness (often n middle of night)
• Wheeze
• Anxiety
• Cold sweat
• Cough with frothy pink sputum
• Grey and/or cyanosed
• Tachypnoea
• Peripherally shut down and cold
• Raised JVP
• Gallop rhythm
• Crackles and wheeze throughout chest
• Hypotension

Immediate investigations

• Chest X-ray - exclude pneumothorax
• Arterial blood gases - low PO2, +- high PCO2
• ECG - arrhythmia

Immediate management

• Sit up
• High-flow oxygen
• I.v. furosemide (frusemide) 40-80 mg
• I.v. diamorphine 2.5-5mg (not if BP < 80 systolic)
• I.v. metoclopramide 10 mg
• I.v. GTN (if not hypotensive)
• Nebulised salbutamol 2.5 mg if bronchospasm