Acute Pulmonary Oedema

Question 1

What are the clinical features of acute pulmonary oedema?

Answer 1

SOB
decreased exercise tolerance
leg swelling
fatigue
weakness

Question 2

What would you find O/E in a patient with acute pulmonary oedema?

Answer 2

Pulmonary crepitations
Peripheral oedema
Raised JVP
Decreased air entry bilaterally

On CXR;
Alveolar oedema
B kerley lines
Cardiomegaly
Dilated upper lobe vessels
Effusions

Question 3

What is acute pulmonary oedema?

Answer 3

Clinical syndrome of reduced cardiac output, tissue hypo perfusion, increased pulmonary pressure and tissue congestion

Question 4

When should CPAP be used?

Answer 4

Type 1 respiratory failure
When ventilation is good but oxygenation is poor

Pulmonary oedema/asthma

Question 5

When should BIPAP be used?

Answer 5

When ventilation is shit and oxygenation is shit (T2RF)

COPD/anything with decreased compliance/elasticity

Question 6

What is Bronchiectasis? How does it present?

Answer 6

Permanent dilation of the bronchi due to destruction and inflammation of bronchial walls.
= bronchial wall oedema, increased mucus production, persistent bacterial colonisation

Majority will present with a chronic cough and sputum production

Question 7

What are the investigations for bronchiectasis?

Answer 7

CXR (tram lines)
CT chest (dilation of bronchi)
FBC (WCC may be high)
Sputum culture (P.aeruginosa)
Spirometry

Question 8

What is the management for bronchiectasis?

Answer 8

Chest physiotherapy
Hydration
Mucolytics (n-acetylcysteine)
Salbutamol, inhaled hypertonic saline, azithromycin

Question 9

What is the management for bronchiectasis in an acute exacerbation?

What is the management for bronchiectasis in a Pseudomonas acute exacerbation?

Answer 9

1) Amoxicillin 500mg PO twice daily

2) Gentamicin 80mg nebulised every 12 hours