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To the Editor.—
Except in those patients with severe chronic pulmonary disease, morphine sulfate has been a time-honored, and an unusually effective, drug. While its precise mode of action is not clear, it certainly does allay anxiety and produce venous pooling. Rotating tourniquets to all four extremities is another quick means to reduce venous return by pooling blood in the extremities. One other useful agent not mentioned in the treatment of acute pulmonary edema is intermittent positive pressure breathing (IPPB) with oxygen bubbled through 50% ethyl alcohol. The alcohol is used for its antifoaming properties; the IPPB, because it tends to lower cardiac output by decreasing venous return and subsequently decreasing left ventricular filling, which improves arterial oxygen tension.
Goodman HB. Morphine for Pulmonary Edema. JAMA. 1974;229(6):638. doi:10.1001/jama.1974.03230440014008
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