In recent weeks, we've highlighted some pearls regarding the management of patients with pulmonary arterial hypertension (PAH).
In the crashing patient with PAH, think about the following:
Catheter occlusion or malfunction (for those receiving IV prostacyclinanalogues)
PE (for those inadequately anticoagulated)
Pneumonia
RV ischemia
GI bleeding
Ischemic bowel
In the patient receiving IV epoprostenol (Flolan) who presents with a catheter occlusion or malfunction, time is of the essence. Restart the medication through a peripheral IV as soon as possible.
References
Rubenfire M, Bayram M, Hector-Wood Z. Pulmonary hypertension in the critical care setting: classification, pathophysiology, diagnosis, and management. Crit Care Clin2007;23: 801-834.
