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Acute Pulmonary Oedema Emergency — FRCA Final MCQ

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ModerateGeneral AnaesthesiaAcute Pulmonary Oedema EmergencyFRCA Final

A 55-year-old man (ASA III) with known dilated cardiomyopathy (EF 25%) is having a pacemaker battery change. He is awake, lying supine, and becomes acutely breathless. You hear bilateral crepitations to the mid-zones and SpO2 drops to 88% on room air. What immediate treatment is most appropriate?

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Correct answer: B — Sit the patient upright, apply high-flow O2, and give IV furosemide 40-80 mg

Acute pulmonary oedema in a patient with known cardiomyopathy requires: (1) sit upright to reduce venous return and improve respiratory mechanics, (2) high-flow oxygen, (3) IV furosemide 40-80 mg (reduces preload via venodilation within minutes, diuresis within 30 minutes), (4) GTN sublingual/infusion if BP allows, (5) CPAP/NIV if not improving with initial measures. IV morphine is no longer routinely recommended for acute pulmonary oedema due to respiratory depression concerns. Intubation is reserved for patients failing non-invasive measures.

Reference: NICE – 2018 – NG106 Acute heart failure; Resuscitation Council UK – 2021