Pulmonary Oedema

Question 1

What is it?

Answer 1

Leakage of fluid into interstitial space resulting in acute severe respiratory impairment

Question 2

What are the causes?

Answer 2

Increased capillary pressure

• cardiac= mitral stenosis/LVF
• pulmonary vein obstruction

Increased capillary permeability

• Infection- pneumonia
• DIC
• Acute resp distress syndrome

PE
Lymphatic drainage obstruction
Neurogenic- raised ICP

Question 3

What are the symptoms?

Answer 3

Dyspnoea
Paroxysmal Nocturnal Dyspnoea
Orthopnoea
Productive cough- frothy and blood stained
Anxiety and palpitations
Cheyne Stokes resp- cycle of apnoea and hyperventilation

Question 4

What are the signs?

Answer 4

Tachypnoea
Tachycardia
Increased venous pressure
Decreased sats
Hypotension- severe and late sign 
Bilateral wheeze and crackles

Question 5

What investigations are needed?

Answer 5

ABG- type 1 resp failure (can lead to type 2)
Bloods
-FBC
-CRP
-U&Es
-D-dimer
-glucose

ECG

ECHO- look for cardiac cause

Question 6

What is the management?

Answer 6

Sit patient upright and give 100% oxygen
IV diamorphine
IV furosemide 40-80mg
GTN spray
SBP>100 then IV nitrates
SBP<100- consider ITU due to cardiogenic shock

Fluid balance
CPAP to help with gas exchange