Cardiovascular Medicine Book

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Acute Pulmonary Edema ManagementAka: Congestive Heart Failure Exacerbation Management

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  1. See Also
    1. Pulmonary Edema
    2. Congestive Heart Failure
    3. Congestive Heart Failure Exacerbation Decision Rule
    4. Heart Failure Causes
    5. Diastolic Dysfunction
    6. Systolic Dysfunction
  2. Indications
    1. Acute Pulmonary Edema secondary to CHF exacerbation
  3. Management: Initial
    1. Furosemide (Lasix) 0.5 to 1.0 mg/kg IV
    2. Morphine 2 to 4 mg IV
    3. Nitroglycerin 0.4 mg SL
    4. Oxygen (with advanced airway management as needed)
  4. Management: Next
    1. Systolic Blood Pressure over 100 mmHg
      1. Nitroglycerin 10 to 20 ug/min IV
      2. Consider Nitroprusside 0.1 to 5.0 ug/kg/min IV
      3. Consider Dobutamine 2 to 20 ug/kg/min IV if no shock
      4. Consider Nesiritide (Natrecor) in refractory cases
    2. Systolic Blood Pressure 70 to 100 mmHg
      1. Dopamine 5 to 15 ug/kg/min IV
  5. Management: Additional Options
    1. Pulmonary artery catheter
    2. Intra-aortic balloon pump
    3. Coronary angiogram
  6. Prognosis
    1. Congestive Heart Failure Exacerbation Decision Rule
  7. References
    1. Ryan (2001) CMEA Internal Medicine Lecture, San Diego
    2. (2000) Circulation 102(suppl I):I

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