Mohamed, a listener from Sudan, emailed asking about the treatment of acute pulmonary edema in patients with low blood pressure. This is in distinction to SCAPE patients (see podcast 1).
If the patients have pulmonary edema and low BP from a cardiac cause, then they are in cardiogenic shock.
First, consider the etiology:
- Valve Disorder
- Ischemic (Right sided infarct, STEMI, NSTEMI)
At the same time, you are treating the patient with:
- Inotropes (dobutamine, milrinone, calcium)
- Pressors to achieve a MAP > 65 (allows coronary perfusion)
- Oxygenation support, most likely with intubation
- Optimize O2 carrying capacity (Hb>10)