Emergency Medicine Board Bombs 263. SCAPE in the ED: Rapid Recognition and Management
Aug 19, 2025
Explore the crucial condition of Sympathetic Crashing Acute Pulmonary Edema (SCAPE) in the emergency department. Learn how to quickly recognize and manage this serious issue with effective treatments like BiPAP and nitroglycerin. The discussion underscores the importance of prompt intervention, achieving noticeable patient improvement in under 20 minutes, while also clarifying the limited use of diuretics in acute situations. Perfect for anyone keen on enhancing their emergency medicine knowledge!
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Start Noninvasive Ventilation Early
- Put suspected SCAPE patients on noninvasive positive pressure ventilation (BiPAP/CPAP) early to reduce intubation and ICU stay.
- Apply BiPAP promptly on arrival rather than waiting for imaging or slow therapies.
SCAPE Is A Rapid Redistribution Syndrome
- SCAPE is not classic fluid overload but a rapid redistribution of intravascular fluid into the lungs from acute elevated filling pressures.
- This triggers a catecholamine surge, tachycardia, reduced filling time, and a vicious cycle that raises blood pressure further.
Real Case: Rapid Nitro Turnaround
- Blake recounts a recent case where EMS started a non-rebreather and nebulizers but the patient remained hypertensive and distressed.
- He gave sublingual nitro and pushed IV nitro immediately when the BP hit 250, which helped rapidly.