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Acute pulmonary oedema — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsAcute pulmonary oedemaSCE Acute Medicine

A 79-year-old man with known severe aortic stenosis presents with acute breathlessness. He is pink and frothy, respiratory rate 36/min, oxygen saturation 82% on air and blood pressure 92/58 mmHg. Chest radiograph shows pulmonary oedema and ECG shows sinus rhythm without ST elevation. What is the most appropriate next step in management?

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Correct answer: A — Give oxygen, start CPAP if tolerated and obtain urgent senior review

This is life-threatening pulmonary oedema with hypotension in severe aortic stenosis, so oxygenation, cautious positive pressure support and urgent senior/cardiology-critical care review are required. High-dose nitrates may precipitate collapse because preload and afterload handling are precarious. Large fluid boluses would worsen pulmonary oedema. The pearl is that the usual pulmonary oedema bundle must be adapted to valve physiology and blood pressure.

Reference: NICE NG106; Resuscitation Council UK ALS