Acute pulmonary edema: the immediate response

Acute cardiogenic pulmonary edema is left ventricular failure driving fluid into the alveoli, so it declares itself as abrupt severe breathlessness with orthopnea, crackles, frothy sputum and a patient who is anxious, diaphoretic and hypoxemic, and the immediate response is to sit the patient upright, restore oxygenation and support the work of breathing, and unload the congested circulation with an intravenous loop diuretic and, where the blood pressure will tolerate it, a vasodilator — all of it begun on the clinical picture rather than held until imaging confirms the cause.