Acute Pulmonary Oedema

Question 1

What is acute pulmonary oedema?

Answer 1

Caused by the build up of excess fluid in the lungs, usually in the air sacs

Question 2

What are the risk factors of acute pulmonary oedema?

Answer 2

• Heart attack
• Leaking, narrowed or damaged blood vessels
• Sudden hypertension
• Pneumonia
• Kidney Failure
• Severe infection causing lung damage
• Severe sepsis

Question 3

What is the differential diagnosis of pulmonary oedema?

Answer 3

• Asthma
• COPD
• Pneumonia

These conditions co-exist in the elderly and are hard to distinguish. Treated simultaneously via:

• Salbutamol nebuliser
• IV furosemide
• Diamorphine
• Amoxicillin

Question 4

What are the categories of the causes of pulmonary oedema?

Answer 4

=> Cardiovascular causes

• LV Heart Failure
• Vascular Heart Disease
• Malignant Hypertension
• Arrhythmias

=> Respiratory causes
- ARDS due to increased capillary permeability

=> Fluid overload

=> Neurogenic
- Increase in pulmonary pressure due to acute CNS injury

Question 5

What are the clinical features of pulmonary oedema?

Answer 5

• Dyspnoea
• Paroxysmal orthopnoea
• Pink frothy sputum
• Distressed
• Pale
• Increased JVP
• Fine lung crackles
• Wheeze

Question 6

What are the investigations in suspected acute pulmonary oedema?

Answer 6

=> CXR
A - Alveolar oedema
B - Kerby B lines
C - Cardiomegaly 
D - Dilated prominent upper lobe veins
E - Small pleural effusions

=> ECG and Echo

=> Bloods
U&E, Troponin, ABG, BNP

Question 7

What is the emergency management of acute pulmonary oedema?

Answer 7

1. Sit patient upright
2. High flow O2 if SaO2 is low
3. IV access and monitor ECG
4. Investigations
5. IV DIAMORPHINE for pain
6. IV FUROSEMIDE
7. GTN SPRAY 2 puffs
8. History, examinations and investigations
9. Nitrate infusion if systolic BP > 100mmHg
10. If patient is worsening:
    - Further furosemide dose
    - Consider CPAP
    - Increased nitrate infusion
    - Consider alternative diagnosis