Way back in episode 1 of EMCrit, I introduced the term SCAPE and discussed this unique clinical presentation. Today, I want to discuss a case of resistant SCAPE posted on twitter. SCAPE is Sympathetic, Crashing Acute Pulmonary Edema. It is a vicious cycle of increased afterload causing LV failure, edema in the longs, an endogenous catecholamine surge, which worsens afterload and so on… What do you do when the normal treatment for SCAPE, nitroglycerin and NIPPV are not working.
The Case…
https://twitter.com/MikePallaci/status/1646988627073802249?s=20
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Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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Any experience with using Phentolamine? Alpha blockade just like for phaeochromocytomas?
Since the pathophysiology is a catecholamine surge, it would make sense to directly block the catecholamine (alpha) effect rather than indirectly vasodilator using CCBs or nitro. Phentolamine is also short acting.
I want to hear more about the logistics of the 60 second art line. I know I can put it in that quickly, but there always seems to be a scavenger hunt for the nursing supplies as well as a nurse that knows how to do it.
A bit off topic: I’m just a young doctor (IM PGY4 at the present time) and recently got to know that the evidence supporting NIV in acute pulmonary edema is not that good as I previously thought, specially after the provoking results of the 3CPO trial.
Any thoughts on that? If you, Josh Farkas or other already discussed it on a previous post, I’d be willing to read/listen.
Thanks!
Hey there, M4 soon to be PGY-1 EM. Was listening to the podcast and it was very briefly mentioned how IPAP may not necessarily be helping patients and could actually be doing harm (unless I misunderstood). Im trying to understand why pressure support (with BiPAP) is not really helpful, while EPAP is really the only important part. At baseline, I understand that EPAP helps reduce dynamic airway collapse and aid in reabsorption of pulmonary edema, but I don’t understand why IPAP is not helpful if not potentially deleterious (which is why we could just use CPAP instead of BiPAP in… Read more »