Pulmonary Edema

Question 1

What is pulmonary edema?

Answer 1

Abnormal accumulation of fluid in the extravascular tissues of the lung. It occurs because of too much pressure in the blood vessels or not enough proteins in the blood stream to hold on to the fluid in the plasma.

Question 2

What conditions can lead to pulmonary edema?

Answer 2

1) Heart disease = cardiogenic pulmonary edema
- occurs due to poor heart function that creates a back pressure into the pulmonary vasculature and fluid leakage into the tissue

2) Non-cardiogenic pulmonary edema

3) Neurological pulmonary edema
- result of brain trauma
- increase intracranial pressure
- seizures

4) Electrocultion

5) Intravascular volume overload
- iatrogenic cause

6) Compromised integrity of alveolar structure
- due to inflammation (sepsis or pancreatitis) leading to leaking alveoli
- actual structural changes to alveoli from smoke inhalation, near drowning, severe uremia, aspirate pneumonia
- or anything that causes severe drop in oncotic pressure

Question 3

What are the clinical signs of pulmonary edema?

Answer 3

Tachypnea, rapid shallow breathing with expiratory push, open mouth breathing or dyspnea, and/or serous nasal discharge

• Cyanosis and frothy pink or bloody discharge may be seen from the nares or mouth
• Harsh lung sounds or crackles
• Exercise intolerance

Question 4

Treatment of pulmonary edema

Answer 4

Address underlying causes.
Loop diuretic furosemide = first line therapy + oxygen
*If patient has cardiac compromise= pressor agents
*very low dose morphine= dilates coronary arteries to improve oxygen delivery to myocardium + slow breathing to increase tidal volume and decrease overall body oxygen requirements
*severe cases: ACE inhibitors and venodilators
*MOST severe cases: mechanical ventilation