Pulmonary edema: Difference between revisions
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*Non-cardiogenic | *Non-cardiogenic | ||
**Hypertensive crisis. | **Hypertensive crisis. | ||
*[[Negative pressure pulmonary edema]] | *[[Negative pressure pulmonary edema]] | ||
**Upper airway obstruction | |||
**Reexpansion edema | |||
*Neurogenic causes | *Neurogenic causes | ||
**[[Seizures]] | **[[Seizures]] | ||
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**[[Pulmonary contusion]] | **[[Pulmonary contusion]] | ||
**Aspiration | **Aspiration | ||
*Immersion pulmonary edema | |||
*Immersion pulmonary edema | |||
*Iatrogenic fluid overload | *Iatrogenic fluid overload | ||
**Multiple blood transfusions | **Multiple blood transfusions | ||
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*Hantavirus pulmonary syndrome | *Hantavirus pulmonary syndrome | ||
*[[High altitude pulmonary edema]] | *[[High altitude pulmonary edema]] | ||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 21:00, 24 March 2015
Background
Causes
- Cardiogenic
- Non-cardiogenic
- Hypertensive crisis.
- Negative pressure pulmonary edema
- Upper airway obstruction
- Reexpansion edema
- Neurogenic causes
- Other
- ARDS
- Inhalation injury
- Pulmonary contusion
- Aspiration
- Immersion pulmonary edema
- Iatrogenic fluid overload
- Multiple blood transfusions
- IV fluid
- Hantavirus pulmonary syndrome
- High altitude pulmonary edema
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