QuestionSBA
QuestionChoice
The patient is clearly fluid overloaded and requires immediate diuresis with a powerful loop diuretic like furosemide
33955
a
Furosemide 40mg IV
QuestionChoice
This novel drug combination is used in the chronic medical management of CCF with reduced ejection fraction and has no role in treating acute fluid overload
33959
e
Sacubitril/valsartan 49/51mg PO
QuestionChoice
Digoxin is a cardiac glycoside that increases myocardial contractility and decreases AV node conduction. It is a useful adjunct in patients with CCF and concomitant AF
33957
c
Digoxin 750 micrograms PO
QuestionChoice
This would be an option in acute pulmonary oedema unresponsive to initial medical therapy
33956
b
CPAP therapy
QuestionChoice
A glyceryl trinitrate infusion can be a useful adjunct treatment in fluid overload secondary to CCF. The patient’s blood pressure must be monitored closely due to its potent vasodilatory effects
33958
d
Glyceryl trinitrate 100 micrograms/kg IV
QuestionComment
Patient has low sats with 92% - treat what kills first, patient should receive CPAP first
17451
QuestionComment
Correct! But the reason this patients sats are low is because of the pulmonary oedema. The fluid within the interstitial spaces is reducing gas exchange, hence the hypoxaemia. The only way to fix this is to get the fluid out of the lungs! 
CPAP would help and is indicated for cardiogenic pulmonary oedema - but it splints the airways open allowing for more gas exchange in the alveoli by preventing them from collapsing. This would be a temporary solution only (often used for patients who don't respond to medical treatment) and giving furosemide would actually likely solve the problem all together :) 
This is why furosemide is indicated first. Hope this helps!
17617
User
subscriber
Myotonia Hypertension
User
subscriber
Loose Contusion
QuestionComment
can PE be excluded in this case?
61063
User
subscriber
Ortho bro
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2735
Acute pulmonary oedema - furosemide for symptomatic relief
Topic
9
Internal Medicine
6802
Case Presentation: A 72 year old woman presents to A&E with acute shortness of breath and chest pain. **PH** congestive cardiac failure, recurrent DVTs, osteoporosis. **DH** bisoprolol fumarate 7.5mg PO OD, lisinopril 40mg PO OD, spironolactone 50mg PO OD, warfarin sodium 8mg PO OD, alendronic acid 70mg PO once weekly, calcichew D3.


**O/E**

HR 98, RR 36, BP 149/97, Temperature 37.2°C, O2 92% RA. HS I + II + ?III, bibasal fine creps. Pitting oedema to buttocks.

She has been sat upright and started on 6L O2 via simple face mask.

**Investigations**

ECG: sinus tachycardia

Question: Select the most appropriate management at this stage.
a