Pulmonary edema: Difference between revisions
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==Management== | ==Management== | ||
*CPAP/BiPAP with PEEP 6-8; titrate up to PEEP of 10-12 | |||
*Nitroglycerin | |||
**Dosing Options | |||
***Sublingual 0.4 mg q5min | |||
***Nitropaste (better bioavailability than oral Nitroglycerin) | |||
***Intravenous: 0.1mcg/kg/min - 5mcg/kg/min | |||
****Generally start IV Nitroglycerin 50mcg/min and titrate rapidly (150mcg/min or higher) to symptom relief | |||
****Nursing may be resistant. Explain that 1 SL tab (400 mcg) Q4min = 100 mcg/min for perspective. | |||
*If NTG fails to reduce BP consider nitroprusside (reduces both preload and afterload) or ACE-inhibitiors (preload reducer) | *If NTG fails to reduce BP consider nitroprusside (reduces both preload and afterload) or ACE-inhibitiors (preload reducer) | ||
*After pt improves titrate down NTG as enaliprilat (0.625 - 1.25mg IV) or captopril are started | *After pt improves titrate down NTG as enaliprilat (0.625 - 1.25mg IV) or captopril are started | ||
Revision as of 22:18, 9 October 2015
Background
Pulmonary Edema Types
Pulmonary capillary wedge pressure <18 mmHg differentiates noncardiogenic from cardiogenic pulmonary edema[1]
- Cardiogenic pulmonary edema
- Noncardiogenic pulmonary edema
- Negative pressure pulmonary edema
- Upper airway obstruction
- Reexpansion pulmonary edema
- Strangulation
- Neurogenic causes
- Iatrogenic fluid overload
- Multiple blood transfusions
- IV fluid
- Inhalation injury
- Pulmonary contusion
- Aspiration pneumonia and pneumonitis
- Other
- High altitude pulmonary edema
- Hypertensive emergency
- ARDS
- Flash pulmonary edema
- Immersion pulmonary edema
- Hantavirus pulmonary syndrome
- Missed dialysis in kidney failure
- Naloxone reversal
- Negative pressure pulmonary edema
Clinical Features
- Crackles
- Respiratory distress
Differential Diagnosis
Acute dyspnea
Emergent
- Pulmonary
- Airway obstruction
- Anaphylaxis
- Angioedema
- Aspiration
- Asthma
- Cor pulmonale
- Inhalation exposure
- Noncardiogenic pulmonary edema
- Pneumonia
- Pneumocystis Pneumonia (PCP)
- Pulmonary embolism
- Pulmonary hypertension
- Tension pneumothorax
- Idiopathic pulmonary fibrosis acute exacerbation
- Cystic fibrosis exacerbation
- Cardiac
- Other Associated with Normal/↑ Respiratory Effort
- Other Associated with ↓ Respiratory Effort
Non-Emergent
- ALS
- Ascites
- Uncorrected ASD
- Congenital heart disease
- COPD exacerbation
- Fever
- Hyperventilation
- Interstitial lung disease
- Neoplasm
- Obesity
- Panic attack
- Pleural effusion
- Polymyositis
- Porphyria
- Pregnancy
- Rib fracture
- Spontaneous pneumothorax
- Thyroid Disease
- URI
Diagnosis
Management
- CPAP/BiPAP with PEEP 6-8; titrate up to PEEP of 10-12
- Nitroglycerin
- Dosing Options
- Sublingual 0.4 mg q5min
- Nitropaste (better bioavailability than oral Nitroglycerin)
- Intravenous: 0.1mcg/kg/min - 5mcg/kg/min
- Generally start IV Nitroglycerin 50mcg/min and titrate rapidly (150mcg/min or higher) to symptom relief
- Nursing may be resistant. Explain that 1 SL tab (400 mcg) Q4min = 100 mcg/min for perspective.
- Dosing Options
- If NTG fails to reduce BP consider nitroprusside (reduces both preload and afterload) or ACE-inhibitiors (preload reducer)
- After pt improves titrate down NTG as enaliprilat (0.625 - 1.25mg IV) or captopril are started
- Morphine is no longer recommended do to increased morbidity
Disposition
See Also
- Congestive Heart Failure (CHF)
- Acute Respiratory Distress Syndrome
- Sympathetic crashing acute pulmonary edema (SCAPE)
References
- ↑ Clark SB, Soos MP. Noncardiogenic Pulmonary Edema. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 1, 2020.