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Lesson

CHF & Pulmonary Edema

12 min Medical

Objective: Tell wet-lung pump failure from COPD when you can, sit them up, use CPAP when it fits, and do not drown a cardiogenic patient in fluids.

Why This Is Hard

Wheeze is not a diagnosis. Cardiac asthma, COPD, pneumonia, and PE all make people work to breathe. The CHF picture is often nocturnal dyspnea, orthopnea, wet crackles, hypertension, JVD, and a cardiac history. Get it wrong and you either bag an obstructive lung like a CHF or flood a failing pump with saline.

Field Picture

  • Sudden severe dyspnea, especially lying flat; pink frothy sputum is late and classic when present.
  • Hypertension is common in flash edema; hypotension is a different, sicker cardiogenic shock picture (see shock categories).
  • 12-lead: ischemia may be the trigger. Do not skip it because they are “just short of breath.”

EMS Priorities

  1. Sit up. High-flow O₂ as needed; titrate (oxygen lesson).
  2. CPAP/NIV if they are alert enough and not vomiting/hypotensive (CPAP lesson).
  3. Nitroglycerin only if authorized, not hypotensive, and not in a right-ventricular / PDE5 caution picture (nitro lesson).
  4. Avoid large empiric fluid boluses. This is not hypovolemic trauma.
  5. Destination and early notification. They can crash after a good first 10 minutes.

Field Pitfalls

  • Albuterol-only tunnel vision because you heard a wheeze.
  • CPAP on a lethargic, vomiting patient.
  • Nitro into a hypotensive inferior/right MI.
Say out loud
  • Orthopnea, wet crackles, often HTN, cardiac history
  • Sit up — CPAP if airway protected and BP allows
  • No trauma-style fluid boluses
  • 12-lead — ischemia may be the trigger

Practice

60-second drill

Two wheeze patients: barrel-chest COPD smoker vs wet, hypertensive CHF with orthopnea. State your first three actions for each and why fluids are the wrong reflex in the second.

Related: CPAP, Nitroglycerin.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.

1. Awakened gasping, sits bolt upright, wet crackles, BP high, CHF history. Best picture:
2. That wet hypertensive patient is alert and protecting the airway. Best next themes:
3. Partner opens fluids “wide open” for this flash-edema picture. That move is:
4. You hear wheezes on that CHF-looking patient. What does wheeze mean here?
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