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SCAPE acute pulmonary oedema — RCPSC EM MCQ

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HardCardiovascular emergenciesSCAPE acute pulmonary oedemaRCPSC EM

CTAS 1: A 72-year-old with hypertension arrives gasping and diaphoretic. Vitals are BP 226/128, HR 132, RR 36, SpO2 78% on room air. Crackles are diffuse and POCUS shows B-lines with preserved LV squeeze. ECG shows LVH without STEMI. What is the most appropriate initial management?

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Correct answer: C — Non-invasive ventilation plus high-dose nitrates

Sympathetic crashing acute pulmonary oedema is primarily afterload excess. NIV and aggressive nitrates rapidly improve work of breathing and haemodynamics.

Reference: Canadian EM acute heart failure practice; ACLS respiratory failure principles