Pulmonary Edema

Question 1

A 70-year-old post-abdominal surgery male patient. Fluid chart + vitals chart inside the station. Patient has taken about 7 liters of fluids (4L of normal saline & 3Ls of Hartman’s), now he is tachycardiac, hypertensive, desaturated, oliguric.

Q1: What are your expected physical findings?

Answer 1

1. Signs of fluid of overload like; congested neck veins, puffiness of face and confusion.

Question 2

Given the following CXR .-
Q2. Interpret this CXR?

Answer 2

2. Pulmonary Edema; prominent aortic nuckle, curly B lines and cardiomegaly

Question 3

Q3. What the Chest x-ray findings in pulmonary edema?

Answer 3

3. karely b lines , cardiomegaly, dilated upper lobe vessels, alveolar Edema

Question 4

Q8. How to manage Fluid overload?

Answer 4

8. According to CCRISP; IV lasix and nitroprusside, aminophylline and inotropic agents

Question 4

Q4. Why this patient is on high risk of MI?

Answer 4

4. Tachycardia will decrease diastole time which is very important for Coronary filling and increasing cardiac load.

Question 5

Q5. What is the minimal UOP?

Answer 5

5. Adult 0.5 ml/kg/hr

Question 5

Q6. Can you explain why the patient is oliguric?

Answer 5

6. Most common due to stress of surgery –> release of gluco/mineralocorticoid –> salt and water retention,, Congestive heart failure and low renal perfusion, also release of ADH due to ansthetic gases leading salt and water retention.

Question 6

Q7. Explain what are the fluids given to this patient?

Answer 6

7. Crystaloids 4 ls of NaCl (from stem)

Question 7

Q10. What can be done to prevent this from happening again?

Answer 7

10. central line and monitor the cvp, monitor urinary output, Incident report, better training of the junior staff.

Question 8

Q11. Management?

Answer 8

11. CCRISP; stop all IV fluids, High O2 , IV frusamide, gtn infusion if sbp> 100, liaise with ITU reg., req –> cxr , ABG electrolytes, ECG, vent support (non-invasive), medical like nitrates , ACEI and dobutamine.

Question 9

Q12. If you have been called for an emergency in OT while you are managing your patient?

Answer 9

12. I will send one of my colleagues to see the emergency case.

Question 10

Q13. How to monitor your patient response?

Answer 10

13. Vital signs, CVP, check ABG and Na serum levels

Question 11

Q14. What’re ECG changes In pulmonary edema?

Answer 11

14. Deep Q wave, ↑ QRS amplitude, evidence of acute Mi, Arrhythmias.