Acute pulmonary edema is characterized by rapid transudation of excess fluid in the lungs secondary to increased pulmonary artery wedge pressure. With full-blown pulmonary edema, patient is anxious and tachypenic, produces frothy and blood-tinged sputum. Findings on the chest are bilateral rales and rhonchi. Chest radiography may show diffuse haziness of the lung fields with greater density in the hilar region. The cause of heart failure may be left atrial outflow impairment-e.g. mitral stenosis; left ventricallar dysfunction-e.g. ischemic heart disease; left ventricular volume overload and left ventricular out flow tract obstruction.

Diagnosis can be made clinically and by chest radiography.

Treatment:

Supportive care

100% oxygen via facemask

If oxygenation remains inadequate use mechanical ventilation.

Apply rotating cuff and keep the patient at semi-sitting position.

Drug treatment

Morphine, i.v. 2-5 mg, over 3 minutes, which can be repeated at 15 minutes interval.

S/E: diaphoresis, nausea hypotension & bradycardia.

C/I: head injury, elevated intra-cranial pressure

Dosage forms: Injection (hydrochloride), 10 mg/ml in 1 ml ampoule; tablet (sulphate), 5mg, 10mg, 15mg, 20mg, 30mg; granules for oral suspension, 20mg, 60mg; capsule (modified release), 20mg, 50mg, 100mg.

PLUS

Furosemide, i.v. 40 mg followed by 80 mg 1 hour later if required.

S/E: hyponatraemia, hypokalaemia and hypomagnesaemia alkalosis

C/I: precomatose states associated with liver cirrhosis, renal failure with anuria

Dosage forms: tablet, 40 mg, 80 mg; injection, 10mg/ml in 2ml ampoule

PLUS

Nitroglycerin, 0.5mg sublingual

S/E: hypotension;

C/I: systolic blood pressure less than 100mm Hg, clinical suspicion of right ventricular infarction.

Dosage forms: tablet (sublingual), 0.5 mg.

PLUS

Dopamine, i.v, 5-10 µg/kg per min.

S/E: tachyarrhythmea.

C/I: idiopathic hypertrophic subaortic stenosis

Dosage forms: powder for injection, 250mg in vial.