emDOCs.net Emergency Medicine (EM) Podcast Episode 123: Sympathetic Crashing Acute Pulmonary Edema
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Jul 21, 2025 Dive into the complexities of sympathetic crashing acute pulmonary edema, known as SCAPE. Discover key characteristics and causes that lead to this critical condition. Learn about effective diagnostic techniques and treatment options. The importance of rapid response and non-invasive ventilation is emphasized, along with the cautious use of medications like nitroglycerin. This engaging discussion provides essential insights for managing respiratory distress in emergency situations.
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SCAPE Pathophysiology Insight
- SCAPE is a subtype of acute heart failure with sudden onset and severe respiratory distress.
- It involves uncontrolled sympathetic activity causing hypertension and fluid redistribution into the lungs.
Troponin and BNP Role Insight
- Troponin elevation in SCAPE usually reflects demand ischemia rather than acute coronary occlusion.
- BNP is less helpful once diagnosis of acute heart failure is clear in these patients.
Key Diagnostic Tests
- Order an EKG, labs, and chest imaging to identify end organ damage and triggers.
- Prioritize CBC, electrolytes, renal/liver function, and troponin for prognostic value.