CHF is a common problem in the US with over 5 million patients carrying the diagnosis and 500,000 new diagnoses each year.1 Cardiogenic acute pulmonary edema (APE) occurs when blood backs up into the pulmonary vasculature leading to increased oncotic pressure and leakage of fluid into the alveolar spaces. There’s minimal or no role for the administration of loop diuretics early in the management of APE. The majority of patients aren’t volume overloaded. Immediate care should focus on NIPPV and administration of nitroglycerin. In patients with ESRD, dialysis is what’s ultimately going to fix the patient.

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