User:Mr. Ibrahem/Sympathetic crashing acute pulmonary edema

Sympathetic crashing acute pulmonary edema (SCAPE), also known as flash pulmonary edema, is a severe form of pulmonary edema. Symptoms are sudden in onset and include severe shortness of breath. People may also cough up frothy pink sputum, be sweaty, and experience agitation. Wheezing or lung crackles may also be present. Onset is typically over minutes to hours.

Triggers may include not taking blood pressure medication, stimulant use, and stress. Risk factors include hypertension, heart failure, and renal artery stenosis. The underlying mechanism involves activation of the sympathetic nervous system which narrows blood vessels. While fluid is present in the lung, fluid overload is typically not present. Diagnosis is supported by low oxygen, mean arterial pressure > 120 mmHg, and ultrasound of the lungs. It is a type of acute decompensated heart failure.

Typically recommended initial treatments include non invasive positive pressure ventilation (NIPPV) and intravenous nitroglycerin. NIPPV should use high pressures of 15 to 18 cm H2O and large amounts of nitroglycerin are typically required. If this is insufficient clevidipine, nicardipine, or enalaprilat may be used. Routine use of diuretics, such as furosemide, is not recommended. It generally resolves rapidly, though may recur. It is a relatively common reason to present to the emergency room.