Flash Pulmonary Edema (aka SCAPE)

* “Sympathetic Crashing Acute Pulmonary Edema”











* Pathophysiology – Rapid onset of pulmonary edema caused by sudden hypertension





* Triggers- Missed Medication, Cocaine, Stress/Anxiety





* Increase in BP = Increase in afterload











* Increased afterload causes acute pulmonary edema (in patients with CHF)











* The worsening pulmonary edema causes shortness of breath which worsens blood pressure and further increases afterload























* Presentation- Sudden, severe respiratory distress AND hypertension





* Different than CHF exacerbation





* Not necessarily caused by hypervolemia











* More rapid in onset

















* Typically crackles/rales on exam or diffuse B-Lines on POCUS

















* Treatment





* BiPAP/CPAP











* High Dose Nitroglycerin











* Diuretics IF Hypervolemic