Phlebotomy for Acute Crashing Pulmonary Edema in Dialysis Patients


    Phlebotomy for Acute Crashing Pulmonary Edema in Dialysis Patients

    Image result for bloodletting

    Blood-letting was once one of the main medical treatments offered to patients before the advent of modern medicine, but did you know it is still a possible therapy that can be used in the ED today? According to a study by Eiser et al in 1997, and advocated by Dr. Reuben Strayer on the EM:RAP podcast, phlebotomy can be used as a last-ditch effort for dialysis patients with acute crashing pulmonary edema.

    If your nitro drip and amped-up ventilator settings aren’t cutting it and the renal fellow says your patient’s dialysis won’t be possible for a few hours, removing 200-300 cc’s of blood can be a bridge to definitive treatment. This doesn’t mean that the mainstays of treatment should be ignored (aggressive use of nitro and bipap/intubation), but if your patient continues to desaturate despite your best efforts, this may be a last-ditch tool you can keep in your back pocket for a rainy day.


    Eiser, AR et al. Phlebotomy for pulmonary edema in dialysis patients. Clin Nephrol. 1997 Jan;47(1):47-9. PMID: 9021241

    Strayer, R. (2016, October) Strayerisms: Acute Pulmonary Edema.

    Carl Mickman

    Carl Mickman

    Carl is originally from Minnesota and received his medical degree from LSU New Orleans. He completed residency at Mount Sinai, and will be staying on for the Ultrasound Fellowship. His primary academic interest is in bringing ultrasound technology to low-resource areas and has worked extensively in Haiti and Mozambique.

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