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Acute pulmonary oedema — DipIMC MCQ

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HardMedical EmergenciesAcute pulmonary oedemaDipIMC

A 76-year-old man is sitting bolt upright with severe breathlessness. He has crackles to the apices, SpO2 84% on air, blood pressure 198/112 mmHg, and ECG shows sinus tachycardia without ST elevation. What is the most appropriate drug/dose?

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Correct answer: A — GTN 400 micrograms sublingual repeated according to response and blood pressure

Hypertensive acute pulmonary oedema responds to nitrates, oxygen and ventilatory support where available. Salbutamol is for bronchospasm and may worsen tachycardia if pulmonary oedema is the primary problem. Routine morphine is no longer a default treatment because of respiratory and haemodynamic risks.

Reference: JRCALC Guidelines; NICE acute heart failure guidance