089 – Acute pulmonary oedema with Graeme

You get called to a code blue medical in the maternofetal assessment unit of your labour ward.

A pregnant woman at 35 weeks has presented in severe respiratory distress. Her BP is 220/110, her heart rate 120/min, oxygen sats 88% despite high flow oxygen. She has a history of hypertension, diabetes and amphetamine abuse. You grab the nearby obstetric ultrasound (because it is there) and quickly scan her lungs with the curvilinear probe – all the lung fields are full of B-lines…..

Hi everyone join Graeme and I as we discuss the acute management of this condition, variously known as SCAPE (sympathetic crashing acute pulmonary oedema), flash pulmonary oedema, or hypertensive pulmonary oedema.


Considerations for Patients With Hypertensive Acute Heart Failure: A Consensus Statement from the Society of Academic Emergency Medicine and the Heart Failure Society of America Acute Heart Failure Working Group. J Card Fail. 2016 Aug;22(8):618-27

A critical appraisal of the morphine in the acute pulmonary edema: real or real uncertain? J Thorac Dis. 2017 Jul;9(7):1802-1805. 

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