Recognition of Sympathetic Crashing Acute Pulmonary Edema (SCAPE) and use of high-dose nitroglycerin infusion

The American Journal of Emergency Medicine
Samantha PaoneSheena Punnapuzha

Abstract

Sympathetic Crashing Acute Pulmonary Edema (SCAPE), or flash pulmonary edema, is the extreme end of the acute pulmonary edema spectrum. A sympathetic surge occurs as a result of decreased systemic perfusion resulting in further increases in afterload, causing the patient to decompensate. Patients can decompensate quickly, therefore patients require rapid interventions. The use of high-dose nitroglycerin (HDN) has been a topic of interest as it is believed to achieve preload and afterload reduction. However, its use continues to be controversial due to concerns of drug induced hypotension, syncope or paresthesia. Although there are Free Open Access Medical Education (FOAM) based podcasts as well as few studies to suggest the use of HDN, the evidence is limited by statistical flaws, incomplete dosing parameters and inconsistent methods of administration. In order to address these limitations, a protocol at our ED was created to ensure the safe and effective use of HDN. Here, we present a case of HDN use for the management of SCAPE based on this protocol.

Citations

May 23, 2019·Current Opinion in Critical Care·David H Ingbar
Jan 5, 2020·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Casey PatrickRobert Dickson
Jan 15, 2019·Journal of Pharmacy Practice·Billy SinRobert DiGregorio
Feb 11, 2021·BMJ Case Reports·Prawal ShrimalAbhinav Bansal
Apr 13, 2020·The American Journal of Emergency Medicine·Krisi StempleMark Bisanzo
Dec 29, 2020·The American Journal of Emergency Medicine·Jason R RaggiDaniel J Singer

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