Acute Pulmonary Oedema

Question 1

What are the common causes of Pulmonary Oedema?

Answer 1

Increased capillary pressure –> LVF, fluid overload, VSD
Increased capillary permeability –> ARDS, sepsis, DIC
Reduced plasma oncotic failure –> Renal/liver failure
Lymphatic obstruction
Neurogenic

Question 2

How do patients with pulmonary oedema present?

Answer 2

Dyspnoea
Orthopnoea (PND)
Pink Frothy Sputum

Question 3

What are the signs of pulmonary oedema?

Answer 3

Distressed
Pale
Sweaty
Tachycardic
Tachypnoea
Increased JVP
Basal crackles
Gallop rhythm
Wheeze

Question 4

What is Gallop Rhythm?

Answer 4

3/4 heart sounds on auscultation

sounds like a gallop

Question 5

What is the Diff Dx for someone with signs/symptoms of Pulmonary Oedema?

Answer 5

Chest infection (ie. pneumonia, cultures on sputum)
PE (poss visible on X-ray? Diff history?)
ARDS (can present with oedema, due to primary lung injury/sever systemic illness. Measure PCWP)

Question 6

What are the appropriate investigations for suspected pulmonary oedema?

Answer 6

ABG --> Type 1 resp failure
FBC, U&Es, BM, D-dimer, CRP
CXR
ECG --> Tachycardia, arrhythmia 
Echocardiography

Question 7

What are the CXR signs of pulmonary oedema?

Answer 7

Diffuse haziness (Bat-wing oedema)
Kerley B lines
Upper zone vessel enlargement
Cardiomegaly
Pleural effusions

Question 8

What are the side effects of thiazide diuretics?

Answer 8

Dizzines
Loss of appetite
Itching
Headache
Weakness
Hyperglycaemia
Hyperuricemia
Hypokalemia
Hyponatremia

Question 9

How do ACEIs work?

Answer 9

RAMIPRIL

Inhibit ACE - decrease AII - inhibit RAAS

Question 10

What are the common side effects of ACEIs?

Answer 10

Dry cough
1st dose hypotension
Hyperkalemia
Fatigue
Dizzines
Headaches
Loss of taste

Question 11

How does Spironolactone work?

Answer 11

K+ sparing diuretic

Aldosterone antagonist - Na reabsorption decrease

Question 12

What are the common side effects of Spironolactone?

Answer 12

Hyperkalemia (AF)
Hyponatremia
Hypotension
Ataxia
Drowsiness
Rashes
Gynecomastia

Question 13

What is the management of acute heart failure causing pulmonary oedema?

Answer 13

100% O2
IV diamorphine 1.25-5mg
IV furosemide
GTN (SBP >90)

Question 14

What is cor pulmonale?

Answer 14

RV hypertrophy and RHF due to irreversible structural changes to pulmonary arteries
Typically 2o to pulmonary HTN

Question 15

Describe ARDS

Answer 15

Pulmonary response to direct/indirect insults leading to non-cardiogenic pulmonary oedema

Question 16

What are the direct causes of ARDS?

Answer 16

Aspiration of gastric contents
Smoke/toxin inhalation
Pneumonia
Near-drowning

Question 17

What are the indirect causes of ARDS?

Answer 17

Sepsis
Trauma
Pancreatitis
Transfusion reactions
Anaphylaxis/drug reactions

Question 18

What are the features of ARDS?

Answer 18

Hypoxemia
Absence of signs of raised right atrial pressure
Diffuse bilateral infiltrates on CXR
Impaired lung compliance

Question 19

What are the pathological changes of ARDS?

Answer 19

Neutrophil infiltration of pulmonary capillaries leading to increased permeability
Damage to type 2 pneumocytes causing surfactant depletion and alveolar collapse

Question 20

What is the management of ARDS?

Answer 20

100% O2
Non-invasive positive pressure ventilation (may require mechanical ventilation)
IV nitrates
IV furosemide
Morphine + metocloparmide