Pulmonary edema & Management

Pulmonary edema & Management

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  B Y :D R . H A S E E B T A R I Q Pulmonary Oedema
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  Definition Pulmonary oedema isa condition characterized by fluid accumulation in the lungs caused by extravasation of fluid from pulmonary vasculature in to the Interstitium and alveoli of Lungs.
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  The extent towhich the fluid accumulation occurs in the interstitium depends on:  Hydrostatic pressure ( favors movement into interstitium)  Oncotic Pressure ( favors movement into capillary)
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  CLASSIFICATION According to causepulmonary oedema is classified as:  Cardiogenic Pulmonary Oedema  Non Cardiogenic Pulmonary Oedema  High altitude Pulmonary Oedema (HAPE)
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  Cardiogenic Pulmonary Oedema Itis due to increased pulmonary venous & pulmonary capillary pressure which pushes the fluid in interstitium & alveoli. Following are the causes:  Left Ventricle Failure  Dysrhythmia  LV hypertrophy & Cardiomyopathy  Myocardial Infarction  Left Ventricle Outflow obstruction
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  Non-Cardiogenic Pulmonary Oedema Itis caused due to following main reasons:  Direct injury to lung  Hematogenous injury to lung  Lung injury + Elevated hydrostatic pressure
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  SIGNS & SYMPTOMS DYSPNEA  TACHYPNEA  TACHYCARDIA  CYANOSIS  FROTHY SPUTUM  WHEEZING  CRACKLES  SUDDEN WEIGHT GAIN  DECREASED URINARY OUTPUT
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  DIFFERENTIAL DIAGNOSIS  PNEUMOTHORAX BRONCHITIS  CARDIAC TAMPONADE  COPD  PERICARDITIS  PNEUMONIA
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  INVESTIGATIONS  CXR-PA view ABGs:  Initially Resp.Alkalosis with hypocapnia & hypoxia  LaterHypercapnea  Blood workup  Septic screen
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  Chest X-Ray Appearance B/L perihilar Bat’s Wing appearence  Symmetric opacification of lung fields  Kerley B lines or Septal lines  Cardiomegaly  Peribronchial Cuffing
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  ABGs Report  RespiratoryAlkalosis
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  MANAGEMENT  Give Oxygen. Treat the underlying cause.  Respiratory support (Non-Invasive ventilation, Intubation)  CPAP  Diuretics  Nitrates
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  High Altitude PulmonaryOedema  Occurs in young people who ascend quickly to 2700m or above & perform strenous exercise  Reversible in nature  Low oxygen concentration at high altitudes causes pulmonary vasoconstriction  Mean pulmonary artery pressure rises  Alveolar capillary membrane is damaged leading to oedema
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  Signs & Symptoms: SOB  HEADACHE  INSOMNIA  FLUID RETENTION TREATMENT:  Rapid descent to lower altitudes & administration of oxygen if required.  The medications Acetazolamide, Dexamethasone, or Nifedipine may also be used for prevention.
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