Source: Institute for Clinical Systems Improvement (ICSI). Heart failure in adults.

Bloomington (MN):
Institute for Clinical Systems Improvement (ICSI); 2005 Jun. 106 p.

Acute Pulmonary Edema Algorithm

33
A = Annotation

Acute pulmonary
edema

34

35

SBP > 160?

Consider IV
beta blocker

yes

no
36
SBP > 100?

37
no See Emergent algorithm
box #27, Assess blood
pressure, prefusion,
and volume status

yes
38
Heart rate > 100?

yes

no
39
Volume overload?

40
Loop diuretic,
IV bolus,
consider IV infusion
A
no
42

yes

A
no
41
Nitroglycerin SL
or drip or consider
nesiritide
A

Symptoms
improved?

yes

Stabilized?

45

46

ED observation
or short stay
candidate?

Other causes?

no

50
Other IV therapies having greater risk:
Morphine sulfate
Milrinone
Dobutamine

no

no

51
Consider emergent
imaging and/or
hemodynamic monitoring

47
ED observation or
short stay admission,
return to algorithm #6,
Initiate HF Management

Symptom relief?

no
54
no

Volume
overload,
refractory to initial
therapy?

Return to algorithm
box #6, Initiate HF
management

yes

52
yes

44
Out of guideline consider consultation
and/or tertiary
center referral A

yes

no
48

49
Out of guideline
Consider consultation:
Acute coronary syndrome
Myocarditis
Uncontrolled hypertension
Valvular insufficiency
Non-cardiac etiologies

53
Back to
algorithm box
#43, Stabilized?

43

yes

55
Out of guideline
Consider consultation:
Ultrafiltration
Hemodyalysis

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