Vasodilate arterial side, while maintaining oxygenation
BiPAP with PEEP of 8 mmHg
Titrate PEEP quickly to 12
High dose nitroglycerin over 2 min (at these doses, nitroglycerin has vasodilation > venodilation)
Goal BP at the patient's norm
Load 800 mcg over 2 min (may start at 100 mcg/min, then titrate rapidly to 400 mcg/min for 2 min)
Then start maintenance at 100 mcg/min, titrate up as needed
NOTE: it takes time to set up nitroglycerin drip, so consider SL nitroglycerin in interim
0.4mg tab during 5 min = ~80 mcg/min (2 tabs = ~160 mcg/min, etc.)
Difficult to titrate if giving more than 1-2 tabs
Patients are likely more dehydrated that overloaded but should be recurrently volume assessed
Consider captopril 12.5 - 25mg SL for continuation of afterload reduction
Wean CPAP after sustained BP at patient's baseline
Decrease FiO2 to 40%
Wean PEEP down 2 cm H2O q10 min
At 5 cmH2O, trial of NC
Titrate PEEP quickly to 12
Goal BP at the patient's norm
Load 800 mcg over 2 min (may start at 100 mcg/min, then titrate rapidly to 400 mcg/min for 2 min)
Then start maintenance at 100 mcg/min, titrate up as needed
NOTE: it takes time to set up nitroglycerin drip, so consider SL nitroglycerin in interim
0.4mg tab during 5 min = ~80 mcg/min (2 tabs = ~160 mcg/min, etc.)
Difficult to titrate if giving more than 1-2 tabs
0.4mg tab during 5 min = ~80 mcg/min (2 tabs = ~160 mcg/min, etc.)
Difficult to titrate if giving more than 1-2 tabs
Decrease FiO2 to 40%
Wean PEEP down 2 cm H2O q10 min
At 5 cmH2O, trial of NC
Furosemide
Targets kidneys which are poorly perfused in BOTH hypotension and catecholamine surge
Consider waiting until BiPAP and nitroglycerin control hypertension first
Nitroprusside, alternative when insufficient response to NTG
Start 0.5 mcg/kg/min, titrate to blood pressure
Max 10 mcg/kg/min for x10 min
Cyanide toxicity risk increases proportionately with infusion rate as well as length of time
If intubation required, consider delayed sequence intubation
Targets kidneys which are poorly perfused in BOTH hypotension and catecholamine surge
Consider waiting until BiPAP and nitroglycerin control hypertension first
Start 0.5 mcg/kg/min, titrate to blood pressure
Max 10 mcg/kg/min for x10 min
Cyanide toxicity risk increases proportionately with infusion rate as well as length of time
Flash pulmonary edema
Pulmonary capillary wedge pressure <18 mmHg differentiates noncardiogenic from cardiogenic pulmonary edema[1]
Immersion pulmonary edema
Cardiogenic pulmonary edema
Reexpansion pulmonary edema
Noncardiogenic pulmonary edema
Acute chest syndrome
Negative pressure pulmonary edema