Podcast 723: Nitro Drip in Flash Pulmonary Edema

<p><strong>Contributor: Alec Coston, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Flash pulmonary edema or Sympathetic Crash Acute Pulmonary Edema (SCAPE) is a severe illness that requires aggressive treatment</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Often in patients with heart failure and a sympathetic surge increasing heart rate, decreased diastolic filling, increased preload, and increased afterload causing pulmonary edema</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Clinical diagnosis: acute onset diaphoresis and respiratory distress, hypoxia and tachypnea on exam</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Bedside lung ultrasound will demonstrate B-lines, indicative of pulmonary edema</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Treatment is nitroglycerin and BiPAP</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Nitroglycerin drip can be started at 80 micrograms/minute, which is similar to the dose delivered by sublingual nitroglycerin</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Stemple K, DeWitt KM, Porter BA, Sheeser M, Blohm E, Bisanzo M. High-dose nitroglycerin infusion for the management of sympathetic crashing acute pulmonary edema (SCAPE): A case series. Am J Emerg Med. 2021;44:262-266. doi:10.1016/j.ajem.2020.03.062</span></p> <p><span style="font-weight: 400;">Agrawal N, Kumar A, Aggarwal P, Jamshed N. Sympathetic crashing acute pulmonary edema.</span> <em><span style="font-weight: 400;">Indian J Crit Care Med</span></em><span style="font-weight: 400;">. 2016;20(12):719-723. doi:10.4103/0972-5229.195710</span></p> <p><span style="font-weight: 400;">Wilson SS, Kwiatkowski GM, Millis SR, Purakal JD, Mahajan AP, Levy PD. Use of nitroglycer