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Tim CP3 @ UoN - Medicine & Surgery > Acute Pulmonary Oedema > Flashcards

Acute Pulmonary Oedema Flashcards

1
Q

What are the common causes of Pulmonary Oedema?

A

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

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2
Q

How do patients with pulmonary oedema present?

A

Dyspnoea
Orthopnoea (PND)
Pink Frothy Sputum

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3
Q

What are the signs of pulmonary oedema?

A 
Distressed
Pale
Sweaty
Tachycardic
Tachypnoea
Increased JVP
Basal crackles
Gallop rhythm
Wheeze
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4
Q

What is Gallop Rhythm?

A

3/4 heart sounds on auscultation

sounds like a gallop

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5
Q

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

A

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)

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6
Q

What are the appropriate investigations for suspected pulmonary oedema?

A

ABG –> Type 1 resp failure due to hyperventilation, later type 2 resp failure due to impaired gas exchange
FBC, U&Es, BM, D-dimer, CRP
CXR - diffuse haziness (bat wing oedema) with Kerley B lines and upper zone vessel enlargement, cardiomegaly pleural effusions
ECG –> Tachycardia, arrhythmia
Echocardiography

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7
Q

What are the CXR signs of pulmonary oedema?

A 
Diffuse haziness (Bat-wing oedema)
Kerley B lines
Upper zone vessel enlargement
Cardiomegaly
Pleural effusions
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8
Q

What are the side effects of thiazide diuretics?

A 
Dizzines
Loss of appetite
Itching
Headache
Weakness
Hyperglycaemia
Hyperuricemia
Hypokalemia
Hyponatremia
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9
Q

How do ACEIs work?

A

RAMIPRIL

Inhibit ACE - decrease AII - inhibit RAAS

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10
Q

What are the common side effects of ACEIs?

A 
Dry cough
1st dose hypotension
Hyperkalemia
Fatigue
Dizzines
Headaches
Loss of taste
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11
Q

How does Spironolactone work?

A

K+ sparing diuretic

Aldosterone antagonist - Na reabsorption decrease

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12
Q

What are the common side effects of Spironolactone?

A 
Hyperkalemia (AF)
Hyponatremia
Hypotension
Ataxia
Drowsiness
Rashes
Gynecomastia
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13
Q

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

A

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

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14
Q

What is cor pulmonale?

A

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

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15
Q

Describe ARDS

A

Pulmonary response to direct/indirect insults leading to non-cardiogenic pulmonary oedema
Acute respiratory distress syndrome (ARDS) is caused by the increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli, i.e. non-cardiogenic pulmonary oedema.
Acute respiratory distress syndrome (ARDS) is type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs

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16
Q

What are the direct causes of ARDS?

A

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

17
Q

What are the indirect causes of ARDS?

A 
Sepsis
Trauma
Pancreatitis
Transfusion reactions
Anaphylaxis/drug reactions
18
Q

What are the features of ARDS?

A

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

19
Q

What are the pathological changes of ARDS?

A

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

20
Q

What is the management of ARDS?

A
  • due to the severity of the condition patients are generally managed in ITU
  • oxygenation/ventilation to treat the hypoxaemia
  • general organ support e.g. vasopressors as needed
  • treatment of the underlying cause e.g. antibiotics for sepsis
  • certain strategies such as prone positioning and muscle relaxation have been shown to improve outcome in ARDS

Tim CP3 @ UoN - Medicine & Surgery (136 decks)

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