SCAPE Management

🚩ACLS Lecture: https://tinyurl.com/emnoteacls SCAPE — Sympathetic Crashing Acute Pulmonary Edema Key point: Hypertensive acute pulmonary edema from sympathetic surge + increased SVR. Treated with high-dose nitrates + NIPPV to avoid intubation/fluid overload paradigm. Pathophysiology: Sympathetic surge → RAAS activation → vasoconstriction → fluid redistributed into lungs (not true fluid overload) Treatment Paradigm: 1. SL NTG 0.6 mg × 3 doses 2. IV NTG bolus 1 mg q2min (max 10 mg) 3. Infusion 40-250+ μg/min (need arterial dilation dose much higher than conventional CHF doses) 4. BiPAP early 5. Avoid diuretics alone — not the primary problem Target: SBP ↓ to ~140 mmHg — most avoid ICU/intubation Contraindications: Aortic stenosis, recent PDE5i, HOCM, hypotension