Pulmonary Edema

Question 1

A pt with one or more of these issues would be considered for what Dx?
(1) Acute onset or worsening of dyspnea at rest.
(2) Tachycardia, diaphoresis, cyanosis.
(3) Pulmonary rales, rhonchi; expiratory wheezing.
(4) Radiograph shows interstitial and alveolar edema with or without cardiomegaly.
(5) Arterial hypoxemia.

Answer 1

Pulmonary Edema

Question 2

Typical causes of acute cardiogenic pulmonary edema:

Answer 2

-Acute myocardial infarction or severe ischemia
-Exacerbation of chronic heart failure.
-Acute volume overload of the LV (Valvular regurgitation).
-Mitral stenosis

Question 3

Most common presentation of Pulmonary edema in developed countries is one of acute or subacute deterioration of

Answer 3

chronic heart failure

Question 4

Can these things cause PE?
(a) Intravenous opioids.
(b) Increased intracerebral pressure.
(c) High altitude
(d) Sepsis
(e) Shock

Answer 4

Yes, Non-cardiac cause

Question 5

Your pt presents with these issues acutely what do you suspect?
(a) Severe dyspnea
(b) Production of pink, frothy sputum.
(c) Diaphoresis
(d) Cyanosis.

Answer 5

Pulmonary edema

Question 6

True/False
Pulmonary edema
Rales are present in all lung fields, as are generalized wheezing and rhonchi

Answer 6

True

Question 7

What are some CXR findings for PE

Answer 7

(a) Pulmonary vascular redistribution..
(b) Blurriness of vascular outlines
(c) Increased interstitial markings.
(d) Butterfly pattern of distribution of alveolar edema.

Question 8

echocardiography:
Substantial proportion of patients has normal EFs with elevated atrial pressures due to _______

Answer 8

diastolic dysfunction

Question 9

What are some DDxs for PE

Answer 9

(1) Cardiac
(2) Pulmonary
(3) Trauma
(4) GI
(5) Musculoskeletal
(6) Psych

Question 10

In full-blown pulmonary edema, the patient should be placed in a sitting position with legs dangling over the side of the bed. How does this help?

Answer 10

Facilitates respiration and reduces venous return.

Question 11

Tx for PE
True/False
Patients can be left on room air, there is no need to monitor the O2 as there is only fluid in the lungs.

Answer 11

FALSE
Oxygen is delivered by mask to obtain adequate oxygenation. Monitor O2 Sat.

Question 12

If respiratory distress remains severe what interventions would you consider?

Answer 12

endotracheal intubation and mechanical ventilation may be necessary.

Question 13

What meds is highly effective in pulmonary edema and may be helpful in less severe decompensations when the patient is uncomfortable for PE?

Answer 13

Morphine

Question 14

Would you give morphine with opioid-induced pulmonary edema?

Answer 14

NO, Give naloxone

Question 15

True/False
Morphine increases venous capacitance, lowering la pressure, and relieves anxiety, which can reduce the efficiency of ventilation

Answer 15

True

Question 16

________ therapy is usually indicated even if the patient has not exhibited prior fluid retention

Answer 16

Intravenous diuretic Therapy

Question 17

What are the Diuretics used for PE

Answer 17

Furosemide (Lasix), 20 - 80mg IV/IM/PO
-increase by 20 - 40 mg q6- 8h until desired response is achieved max 600mg/day.
Bumetanide (Bumex), 1 mg IV/PO

Question 18

What is the max dose for furosemide?

Answer 18

600mg/day

Question 19

True/False
Disposition of PE patients
In most cases, pulmonary edema responds slowly to therapy

Answer 19

FALSE
responds rapidly

Question 20

What is a complication for PE

Answer 20

Bronchospasm
(may occur in response to pulmonary edema and may itself exacerbate hypoxemia and dyspnea.)

Question 21

How would you tx a bronchospasm that occurred in response to PE

Answer 21

Beta-adrenergic agonists or intravenous aminophylline