APO management

Signs

Hypoxia

Increased airway pressures

Pink frothy sputum up ETT

Creps or wheeze

Respiratory distress

Precipitating factors

Fluid overload

Cardiogenic

Non-cardiogenic - aspiration

Emergency management

POND

Position/Pressure (head tilt up, PEEP)

Oxygen (titrate fi02 against Sp02)

Nitrates - preload reduction if SBP >100 (GTN spray 400mcg S/L PRN, GTN infusion 10mcg/min)

Diuretics - fluid reduction (frusemide 0.5mg/kg IV 20mins PRN

If not responding despite above, commence milrinone (50mcg/kg IV slowly over 10mins - followed by infusion adjusted to response up to 0.75mcg/kg/min

If AF with RVR which is thought to be contributing (Amiodarone load, consider DCR)

Subsequent management

Consider and investigate likely cause

Review perioperative fluid balance

Cardiac investigations

ECG

Cardiac enzymes

Echocardiogram

CXR

Consider admission to HDU/ICU

Inform relatives

Document

Other Non-cardiogenic ppt factors

Post airway obstruction

Anaphylaxis

Neurogenic

Sepsis