In this episode we talk with Michael Perlmutter (@DitchDoc14) who recently released a poster board for an upcoming paper evaluating the safety and efficacy of push-dose nitroglycerin in EMS for patients experiencing sympathetic induced pulmonary edema. In this episode you will hear us refer to this subset as "SCAPE" patients. This term was coined by Scott Weingart in his very first EMCrit podcast and stands for sympathetic crashing acute pulmonary edema (SCAPE). The safety of this method is extremely beneficial for services that do not have access to an IV pump.

Heres is the assessment and treatment algorithm that was used in the study:

Mike and I discuss how the degree of afterload that inhibits forward ejection from the left ventricle (LV) is relative to health of the LV. It is important to stress that blood pressure does not need to be extremely high in order for CO to be inhibited.

Systolic pressure = diastolic pressure + pressure exerted by LV during systole

The afterload or diastolic pressure is a product of cardiac output and peripheral vascular resistance. If we decrease cardiac output (cardiogenic shock) peripheral vascular resistance will likely increase to maintain perfusing MAP. 

This study utilized a systolic metric (120 mmHg after two sprays of subligual nitro) to continue down the path of bolus dose nitro. In my opinion it may be benefical to consider MAP or diastolic inclusion in future studies. In addition to the majority of NIBP utilizing MAP to extrapolate sys/dias, if afterload is inhibiting forward LV flow, pulse pressure will be low.

Here is the entire poster. 



Podcast 96 - Vantage Point:RRT w/ Kristin Ireland

By accepting you will be accessing a service provided by a third-party external to

04 October 2020
FOAMfrat Podcast
FOAMfrat educator @QuilletAustin did a fantastic job on a talk discussing best practices and EBM when it comes to pediatric arrest. I cornered him after the talk to unpack some of the points that stood out to me. I think you all will enjoy the discus...
26 September 2020
FOAMfrat Podcast
  Time is of the essence, right? We do not have time for vitals to improve before we take the airway. Rapid sequence induction has placed an internal clock in the minds of providers.   Waiting for blood pressure to improve or an SPO2 to imp...
21 September 2020
FOAMfrat Podcast
We welcome back Chip Lange for another episode!    Chip has been working on some legislature in his state to increase the the abilities of the PA in the back of an ambulance. But... why should we care? Because we're going to start seeing mo...
10 September 2020
FOAMfrat Podcast
  My buddy Jay Nance and I went on the Mind Body Medic Podcast with absolutely no agenda. This is a podcast within the FlightBridgeED Podcast Network hosted by my dude and friend to FOAMfrat, Chris Meeks. The conversation had limited banter and ...
18 August 2020
FOAMfrat Podcast
The whole FOAMfrat team loves listening to audio books. Last week, Austin Quillet pitched the idea of turning our blogs into a audio book style format. So we figured, why not give it a shot? We put this audio blog into a story format with some sound ...
Don't have an account yet? Register Now!

Sign in to your account