Pulmonary edema: Difference between revisions
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==Background== | ==Background== | ||
===Causes=== | |||
==Causes== | |||
*[[Congestive heart failure|Cardiogenic]] | *[[Congestive heart failure|Cardiogenic]] | ||
*Non-cardiogenic | *Non-cardiogenic | ||
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*Other | *Other | ||
**[[ARDS]] | **[[ARDS]] | ||
**Inhalation | **Inhalation injury | ||
**[[Pulmonary contusion]] | **[[Pulmonary contusion]] | ||
**Aspiration | **Aspiration | ||
**Reexpansion edema (post large volume thoracocentesis, resolution of pneumothorax, post decortication, removal of endobronchial obstruction, effectively a form of negative pressure pulmonary oedema. | **Reexpansion edema (post large volume thoracocentesis, resolution of pneumothorax, post decortication, removal of endobronchial obstruction, effectively a form of negative pressure pulmonary oedema. | ||
Reperfusion injury, i.e. postpulmonary thromboendartectomy or lung transplantation | *Reperfusion injury, i.e. postpulmonary thromboendartectomy or lung transplantation | ||
Immersion pulmonary edema[7][8] | *Immersion pulmonary edema[7][8] | ||
Multiple blood transfusions | *Iatrogenic fluid overload | ||
**Multiple blood transfusions | |||
**IV fluid | |||
*Hantavirus pulmonary syndrome | |||
*[[High altitude pulmonary edema]] | |||
Hantavirus pulmonary syndrome | |||
High altitude pulmonary edema | |||
Envenomation, such as with the venom of Atrax robustus[11] | Envenomation, such as with the venom of Atrax robustus[11] | ||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 20:52, 24 March 2015
Background
Causes
- Cardiogenic
- Non-cardiogenic
- Hypertensive crisis.
- Negative pressure pulmonary edema (Upper airway obstruction)
- Neurogenic causes
- Other
- ARDS
- Inhalation injury
- Pulmonary contusion
- Aspiration
- Reexpansion edema (post large volume thoracocentesis, resolution of pneumothorax, post decortication, removal of endobronchial obstruction, effectively a form of negative pressure pulmonary oedema.
- Reperfusion injury, i.e. postpulmonary thromboendartectomy or lung transplantation
- Immersion pulmonary edema[7][8]
- Iatrogenic fluid overload
- Multiple blood transfusions
- IV fluid
- Hantavirus pulmonary syndrome
- High altitude pulmonary edema
Envenomation, such as with the venom of Atrax robustus[11]
Diagnosis
- 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
Treatment
- 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
- Dosing Options
Generally start IV Nitroglycerin 50mcg/min and titrate rapidly (150mcg/min or higher)to symptom relief
- 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