SCAPE (Sympathetic Crashing Acute Pulmonary Edema) is a specific form of severe heart failure which is seen predominantly in the emergency department and intensive care unit (as opposed to the outpatient cardiology clinic). Consequently, there is a tendency to overlook SCAPE in articles and chapters about heart failure.
SCAPE is critical to recognize and intervene upon, because it is a vicious cycle. Left alone, it will tend to worsen and ultimately precipitate intubation. However, with aggressive management, the vicious cycle can be reversed – leading to a prompt and satisfying clinical improvement.
The IBCC chapter is located 👉 here.
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Thanks for your informative blog.
Is it possible to use Urapidil instead of Nitroglycerin for the treatment of SCAPE.
Hi Josh, thanks for your pearls of knowledge about SCAPE. Just a question on CPAP pressures You suggest to use CPAP with 15-18 cmH2O. However, the vast majority of RCTs included in the Barbenetz Cochrane review use 10 cm of water and this is also our experience. When we apply CPAP the patient is completely free to breathe without any need of synchrony with a ventilator; the higher the initial PEEP the earlier patients improve subjectively and objectively (SpO2 and BGA). When CPAP is applied early at 10, the need of opioids is very rare since e benefit is almost immediate.… Read more »
Great Thanks for sharing such an informative blogs
Hi, thanks for the post! EM Resident here. I have had a few cases where determining whether the patient has true SCAPE vs your so-called FOSPE that’s just finally been tipped over isn’t totally cleared. Getting a good history and understanding the tempo of onset is hard when the patient is on BiPAP breathing at 40 and speaking in one word answers. If the patient looks like HF, has SBP > 160, diffuse B-lines, crackles throughout, and maybe an S3, does it really matter for your acute management? I had this sorta patient the other night and my attending thought… Read more »
Thanks for this post. This articulates this subset of Acute Pulmonary Edema nicely and squares with my experience quite well. I’m old enough to remember NIPPV as an Avante Garde measure which caused colleagues to mutter “You’re not going to intubate?” A few comments from a community hospital perspective: as mentioned by another comenter, CPAP is great and may be better tolerated by some patients, generally, I want to spend as little time convincing my RT to do something they are unaccustomed to so I go with whatever they like (BIPAP in my institution) and change to CPAP if poorly… Read more »
What about paste? On the podcast you mentioned the drip and then using SL quickly in the moment (and removing bipap q2m to give them some sprays) but why not paste and leave the bipap on? As a hospitalist I’m often able to save people from a icu transfer with this combo in step down for a short while (especially during COVID times when our icu is operating at 130% capacity).
Just academic curiosity. How do you name/classify flash pulmonary edema that develops after cardiac output is increased, returning from Cath lab with PPM. From junctional rhythm of 40 to AV paced at 80. POCUS with LV and RV function normal. LVOT VTI at bedside 20 cm LVOTd 2.3 cm (SV 83 ml). Diffuse interstitial syndrome on LUS. IVC small and collapsible consistent with RAP 3 mm HG. Clearly increased cardiac output (from 3.3 to 6.6 l/min) with normal filling pressures.