Pulmonary Oedema

Question 1

How do you treat APO?

Answer 1

GTN 600mcg if SBP >110
or 300mcg if old frail etc

GTN Patch if SBP>90
50mg (0.4mg per hour)

If no improvement use CPAP

Question 2

What are the contraindications for CPAP

Answer 2

HALFGPS

Hypoventilation
Active vomitting
Life threatening arrythmias
Facial trauma
GCS <13
Secure Airway needed
Pneumothorax

Question 3

What are the precautions for CPAP?

Answer 3

COPD - can be used cautiously with monitoring for deterioration

Hypotension

Question 4

What are the indications for CPAP to be removed?

Answer 4

• Cardiac or resp arrest
• Pt agitation/intolerance
• Nil improvement after 1 hour
• HR <50
• SBP<90
• GCS <13
• Decreasing SPO2
• Loss of airway control
• Copious secretions
• Active vomiting
• Paramedic judgment of pt deterioration