Management of severe EOL pulmonary edema

[SurrealMoment]

When encountering a pt hours from death in fulminant pulmonary edema, who is gurgling, drooling out the Roxanol, still conscious....family very alarmed....how do you go about your symptom control?

[ErinS, BSN, RN]

1. Reposition as much as possible for comfort.

2. Call the md and get something other than roxanol. (For us, this would probably be subQ morphine that would likely already be in the home in a 1-time shot form)

3. Educate the family.

Pulmonary edema is one of the disease I pray I never experience in a family member or myself.

[AuntieRN]

atropine drops sl....dries up secretions to help stop the gurgling soum

nds also helps :)

[leslie :-D]

my pts typically have iv access, so it made mgmt much more effective.

lasix, vasodilator of choice, morphine, suction, bronchodilators...

this is from an inpt facility.

much different when it's at home.

lesile

[melsch]

I am in an inpatient setting as well, so my experience my differ as well.

We use SC morphine or dilaudid for pain and to ease the dyspnea symptoms. We use Atropine SC q1h as well, but find that it only keeps more fluid from being produced and works only minimally for large amounts of fluid. We also give regular sedation SC Nozinan or Ativan especially if the patient is at all responsive. Repositioning and cleaning out the mouth as much as possible, and education of the family is really important. We don't suction our patients as a rule - but this is one time that we sometimes do suction for comfort as the amount of fluid build up in the oral cavity can be quite distressing. These are the worst deaths to witness and if the patient is aware I am sure it is one of the worst to experience as well.

[leslie :-D]

These are the worst deaths to witness and if the patient is aware I am sure it is one of the worst to experience as well.

i definitely agree.

that is why we've been so aggressive, because it really is horrible.

and it's pretty standard for our pts to have iv access, in event we need immediate effect from med.

leslie

[nrcnurse]

Lay them flat on their left side, head down, roll them over, and drain them out onto a chux. It sounds gross, but very effective for removing large amounts of secretions. (Tips learned from Continuous Care nurses. Easier to do if family is not @BS watching.) Just repositioning flat on one side can make a HUGE difference in the sound. Airflow is not fighting gravity and fluids in that position. We also use Atropine and Levsin. Both work well. And, do a lot of swabing with toothettes

[BalancingLife]

Lots of good tips here. Positioning and educating family is a must.

We also use scopolamine patches, atropine drops most commonly.

If those aren't making a difference I have seen Robinul given. It's an

anti cholinergic and works really well.

[tewdles, RN]

Subcutaneous scopolamine stat! then the patch (1-3, Q72hr) and Q4hr Atropine or Levsin (whichever your doc prefers). I totally agree that the best thing you can do is get them as dry as possible. I would be looking for another route for the morphine...SL is not the best choice for a person who is drooling. This is from a field nurse.

[leslie :-D]

correct me if i'm wrong, but wasn't the op asking about "fulminant" pulm edema?

fulminant and flash are one and the same, and require stat and aggressive (less being tubed) intervention.

so, are your answers for 'stable' pe or not?

thanks.:)

leslie