| Rural treatment of acute cardiogenic pulmonary edema: applying the evidence to achieve success with failure. | |
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MedLine Citation:
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PMID: 18796257 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Rural management of acute cardiogenic pulmonary edema should be based on avoidance of adverse outcomes such as in-hospital mortality, the need for intensive care unit care, and the need for intubation and mechanical ventilation. Current evidence suggests that early noninvasive continuous positive airway pressure and early aggressive preload reduction with intravenous nitroglycerin are first-line interventions. Afterload reduction with sublingual captopril, with or without nitroglycerin, improves outcomes and is a second-line intervention. Furosemide is associated with adverse outcomes when used alone and should be given only after vasodilator therapy as a third-line intervention. Inotropes should be used only with demonstrably poor perfusion as they do not improve outcomes and may indeed be associated with increased mortality. Concurrent vasodilator therapy should be considered as soon as possible. Morphine should not be used as it is associated with adverse outcomes. If sedation is desirable, benzodiazepines should be considered. |
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Authors:
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John Bosomworth |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Canadian journal of rural medicine : the official journal of the Society of Rural Physicians of Canada = Journal canadien de la médecine rurale : le journal officiel de la Société de médecine rurale du Canada Volume: 13 ISSN: 1203-7796 ISO Abbreviation: Can J Rural Med Publication Date: 2008 |
Date Detail:
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Created Date: 2008-09-17 Completed Date: 2008-11-18 Revised Date: 2009-03-31 |
Medline Journal Info:
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Nlm Unique ID: 9708550 Medline TA: Can J Rural Med Country: Canada |
Other Details:
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Languages: eng Pagination: 121-8 Citation Subset: IM |
Affiliation:
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Department of Family Practice, University of British Columbia, Vancouver, BC. john.bosomworth@interiorhealth.ca |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Angiotensin-Converting Enzyme Inhibitors / administration & dosage, economics, therapeutic use Benzodiazepines / therapeutic use Captopril / administration & dosage, economics, therapeutic use Continuous Positive Airway Pressure / methods* Diagnosis, Differential Diuretics / therapeutic use Emergency Medicine / methods* Furosemide / therapeutic use Heart Failure / complications, therapy* Humans Nitroglycerin / administration & dosage, therapeutic use Pulmonary Edema / etiology, therapy* Treatment Outcome Vasodilator Agents / administration & dosage, therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Angiotensin-Converting Enzyme Inhibitors; 0/Diuretics; 0/Vasodilator Agents; 12794-10-4/Benzodiazepines; 54-31-9/Furosemide; 55-63-0/Nitroglycerin; 62571-86-2/Captopril |
| Comments/Corrections | |
Comment In:
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Can J Rural Med. 2009 Winter;14(1):29; author reply 29-30
[PMID:
19146792
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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