Acute pulmonary edema is a sudden buildup of fluid in the lungs, usually from acute heart failure with high pressures in the heart. The patient becomes very short of breath and hypoxic, and fast treatment with CPAP and nitroglycerin can prevent intubation.
Key symptoms
- Sudden severe shortness of breath, worse lying flat
- Cough with frothy, sometimes pink sputum
- Anxiety, sweating and feeling of drowning
- Chest pain or palpitations in some patients
What you find on exam
- Sitting upright, fast breathing, speaking in short phrases
- Crackles in both lungs, sometimes wheeze
- High blood pressure is common; low pressure is a bad sign
- Raised jugular venous pressure and leg edema
- Cool, sweaty skin and low oxygen saturation
Tests
- Oxygen saturation and waveform capnography
- 12-lead ECG for STEMI or arrhythmia
- Chest X-ray or lung ultrasound with B-lines
- BNP, troponin, electrolytes and kidney function
Treatment basics
- Sit the patient up and give oxygen to correct hypoxia
- CPAP or BiPAP early for respiratory distress
- Nitroglycerin if blood pressure is adequate and no recent erectile dysfunction drugs
- IV furosemide in the hospital for fluid overload
- Treat the cause, such as heart attack or arrhythmia
Red flags
- Low blood pressure or signs of cardiogenic shock
- Drowsiness, tiring out or saturation not improving on CPAP
- ST elevation on the ECG
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; National EMS Education Standards (2021); NREMT psychomotor skill sheets (EMT and Paramedic). Written by Making Synapses. Making Synapses is not affiliated with these organizations.