An 80-year-old male is short of breath and spitting up pink, frothy sputum. He has no improvement after oxygen administration. What should you do?

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Multiple Choice

An 80-year-old male is short of breath and spitting up pink, frothy sputum. He has no improvement after oxygen administration. What should you do?

Acute pulmonary edema from heart failure often presents with shortness of breath and pink, frothy sputum. When oxygen alone doesn’t improve the hypoxia, noninvasive positive-pressure ventilation with CPAP is the best next step. CPAP delivers a constant positive pressure throughout the breath, which helps keep the airways open, increases the amount of air that stays in the lungs after exhalation, and improves gas exchange. It also reduces the workload on the heart and helps push fluid out of the alveoli, easing edema and breathing. The other options aren’t as effective for this scenario: placing the patient in Trendelenburg doesn’t address the underlying edema and can worsen breathing; nebulized albuterol targets bronchospasm and doesn’t treat edema; intubation is reserved if CPAP is not tolerated, if the patient deteriorates, or if there’s an inability to protect the airway, not as the initial move when CPAP is feasible.

Acute pulmonary edema from heart failure often presents with shortness of breath and pink, frothy sputum. When oxygen alone doesn’t improve the hypoxia, noninvasive positive-pressure ventilation with CPAP is the best next step. CPAP delivers a constant positive pressure throughout the breath, which helps keep the airways open, increases the amount of air that stays in the lungs after exhalation, and improves gas exchange. It also reduces the workload on the heart and helps push fluid out of the alveoli, easing edema and breathing.

The other options aren’t as effective for this scenario: placing the patient in Trendelenburg doesn’t address the underlying edema and can worsen breathing; nebulized albuterol targets bronchospasm and doesn’t treat edema; intubation is reserved if CPAP is not tolerated, if the patient deteriorates, or if there’s an inability to protect the airway, not as the initial move when CPAP is feasible.

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