Pharmacy to Dose: The Critical Care Podcast Emergency Medicine Clinical Pearls: Part I
Jul 10, 2025
Caylee Brown, a PGY2 emergency medicine pharmacy resident at Mission Hospital, and Christine Hancock, also a PGY2 resident at the University of Michigan Health, dive into life-saving clinical strategies. They explore the intricacies of managing Sympathetic Crashing Acute Pulmonary Edema, emphasizing the crucial role of high-dose nitroglycerin. Christine shares insights on frostbite treatment, discussing advanced options like thrombolytics and the importance of ongoing research. Their blend of emergency medicine expertise and practical advice makes for an engaging and informative conversation.
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SCAPE Patient Case Example
- A 65-year-old male with heart failure and medication non-compliance presented with severe hypertension and hypoxia.
- EMS used BiPAP and called for a nitroglycerin drip to manage his sympathetic crashing acute pulmonary edema (SCAPE).
Understanding SCAPE Pathophysiology
- SCAPE arises from left ventricular dysfunction causing increased pulmonary pressures and edema.
- A sympathetic surge raises afterload, worsening pulmonary edema in a vicious cycle.
First-line SCAPE Management Strategy
- Use non-invasive positive pressure ventilation plus nitroglycerin as first-line SCAPE management.
- This combination aims to prevent intubation and mechanical ventilation.