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Acute pulmonary oedema

Start this sheet when: Sudden breathlessness with crackles, pink frothy sputum or SpO2 below 94%, usually with high BP, in a patient with heart or kidney disease or a missed dialysis. Low BP with wet lungs is cardiogenic shock: different drugs.

Hospital (remembered on this device)Patient ID / UHID (not saved)Age / SexFilled by

Door dateDoor time (clock starts here)

Time since door

Targets met --Breaches 0

1.Triage, sat up, oxygen started
≤ 5 min from door · ED KPI: triage median 5 min
Enter door time
2.CPAP / NIV started(RR over 25 or SpO2 below 90%)
≤ 15 min from door · ESC 2021: early NIV in distress
N/AEnter door time
3.12-lead ECG done and read
≤ 10 min from door · ESC 2021: at once; look for STEMI and fast AF
Enter door time
4.Nitrate given (SL or IV GTN)(SBP over 110)
≤ 15 min from door · ESC 2021: vasodilator when SBP over 110
N/AEnter door time
5.IV furosemide given (1-2 × home oral dose)(Fluid-overloaded)
≤ 1 h from door · ESC 2021: early IV loop diuretic
N/AEnter door time
6.Gas, troponin, K+, creatinine; lung USG or X-ray
≤ 30 min from door · Local target: never delays NIV or nitrate
Enter door time
7.Cardiology / cath lab called(STEMI or SBP below 90)
≤ 10 min from ECG · ESC 2023: 10 min from diagnostic ECG
N/AEnter door time
8.Response on NIV reviewed (gas repeated)(On NIV)
≤ 1 h from NIV start · BTS/ICS 2016: reassess at 1 h, intubate if failing
N/AEnter door time
9.Spot urine sodium / urine output checked(Diuretic given)
≤ 2 h from furosemide · ESC 2021: at 2 h; below 50-70 mmol/L = double dose
N/AEnter door time
10.Disposition decided
Record · Admit / transfer / OT; for the length-of-stay audit
Enter door time
11.Patient left the ED
≤ 2 h from disposition decision · ED KPI: decision to departure 2 h or less
Enter door time

Bedside checklist

☐Sit up, legs down; oxygen to SpO2 94-98% (88-92% if CO2 retainer)
☐CPAP 5-10 cm H2O works as well as BiPAP unless CO2 is high
☐GTN 400 mcg SL every 5 min, then IV infusion; aim SBP down 20-25%
☐SBP below 90: no nitrate; this is shock, call cardiology, start inotrope
☐No routine morphine: it adds intubations
☐Find the trigger: ACS, BP, arrhythmia, valve, PE, infection, missed dialysis
☐Anuric or on dialysis: dialysis is the diuretic, call nephrology
☐Stop NSAIDs and pioglitazone; watch potassium and creatinine daily

References

Targets marked “local” are suggestions: agree your own with the quality committee before auditing against them.

Bedside checklist

☐Sit up, legs down; oxygen to SpO2 94-98% (88-92% if CO2 retainer)

☐CPAP 5-10 cm H2O works as well as BiPAP unless CO2 is high

☐GTN 400 mcg SL every 5 min, then IV infusion; aim SBP down 20-25%

☐SBP below 90: no nitrate; this is shock, call cardiology, start inotrope

☐No routine morphine: it adds intubations

☐Find the trigger: ACS, BP, arrhythmia, valve, PE, infection, missed dialysis

☐Anuric or on dialysis: dialysis is the diuretic, call nephrology

☐Stop NSAIDs and pioglitazone; watch potassium and creatinine daily