Roshan Mathew, Akshay Kumar, Ankit Sahu, Sachin Wali, Praveen Aggarwal
BACKGROUND: Sympathetic crashing acute pulmonary edema (SCAPE) is a severe form of hypertensive acute heart failure with a dramatic presentation. Rapid identification and management in the emergency department (ED) is key to saving these patients and preventing morbidity associated with endotracheal intubation and intensive care treatment. Use of high-dose nitroglycerin (NTG) and noninvasive ventilation (NIV) has been advocated in management of such patients. OBJECTIVE: To study the feasibility and safety of high-dose NTG combined with NIV in SCAPE...
September 2021: Journal of Emergency Medicine
Samantha Paone, Leigha Clarkson, Billy Sin, Sheena Punnapuzha
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...
August 2018: American Journal of Emergency Medicine
Suprat Saely Wilson, Gregory M Kwiatkowski, Scott R Millis, John D Purakal, Arushi P Mahajan, Phillip D Levy
OBJECTIVES: The purpose of this study was to compare health care resource utilization among patients who were given intravenous nitroglycerin for acute heart failure (AHF) in the emergency department (ED) by intermittent bolus, continuous infusion, or a combination of both. METHODS: We retrospectively identified 395 patients that received nitroglycerin therapy in the ED for the treatment of AHF over a 5-year period. Patients that received intermittent bolus (n=124) were compared with continuous infusion therapy (n=182) and combination therapy of bolus and infusion (n=89)...
January 2017: American Journal of Emergency Medicine
Phillip Levy, Scott Compton, Robert Welch, George Delgado, Alison Jennett, Neelima Penugonda, Robert Dunne, Robert Zalenski
STUDY OBJECTIVE: We perform a feasibility and outcome assessment of the treatment of severe decompensated heart failure with high-dose nitroglycerin. METHODS: This study was designed as a nonrandomized, open-label, single-arm study of high-dose nitroglycerin. Patients with hypertension (systolic blood pressure > or = 160 mm Hg or mean arterial pressure > or = 120 mm Hg) who were refractory to initial therapy were eligible for inclusion. Enrolled patients began receiving a titratable nitroglycerin infusion and were given a bolus of high-dose nitroglycerin (2 mg)...
August 2007: Annals of Emergency Medicine
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