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Pulmonary oedema — DipIMC MCQ

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HardMedical EmergenciesPulmonary oedemaDipIMC

A hypertensive patient with cardiogenic pulmonary oedema remains severely dyspnoeic despite oxygen and initial medical therapy. Arterial pH is 7.20 and consciousness is preserved. Which respiratory escalation best follows NICE guidance?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Start non-invasive ventilation without delay and monitor response

The best answer is “Start non-invasive ventilation without delay and monitor response”. NICE does not recommend routine NIV for every episode of cardiogenic pulmonary oedema, but specifically advises considering it without delay when severe dyspnoea and acidaemia are present or medical therapy is failing. Continuous reassessment is essential, with invasive ventilation if respiratory failure, exhaustion or reduced consciousness develops despite treatment.

Reference: NICE CG187, Acute heart failure: diagnosis and management: https://www.nice.org.uk/guidance/cg187/chapter/recommendations