Left Versus Right Failure
Left-sided failure backs fluid into the lungs, causing crackles, dyspnea, orthopnea, and pink frothy sputum. Right-sided failure causes jugular venous distention, peripheral edema, and hepatic congestion. Many patients have both.
Acute Pulmonary Edema
Patients are anxious, sitting upright, and breathing rapidly with audible wet sounds. CPAP is highly effective because positive pressure pushes fluid back out of the alveoli and reduces work of breathing. Nitroglycerin reduces preload if blood pressure is adequate.
Cautions
Avoid fluid boluses unless the patient is hypotensive for another reason. Not all wheezing is asthma, and cardiac asthma can be mistaken for bronchospasm. Check for medication noncompliance, dietary salt, and recent infections as triggers.