Pulmonary Oedema

Question 1

RF/Causes

Answer 1

Left sided heart failure, valvular conditions, MI, arrhythmias, Hypertension

Question 2

Symptoms and signs

Answer 2

Dysponea, shortness of breath, orthopnoea, chest pain, pink frothy cough, lethargy.

Signs - Unwell and leaning forward, tachypnoea, tachycardia, bilateral fine basal crackles, raised JVP, heaves, heart murmurs.

Question 3

Investigations

Answer 3

DO MANAGEMENT BEFORE INVESTIGATIONS.

Bedside: ECG

Bloods: FBC, UandE, CRP, troponin, BNP. Consider ABG.

Imaging: Echo and CXR.

Question 4

Management

Answer 4

Positioning, upright.
Oxygen, high flow, 15L non rebreathable.
Diuretics, loading dose of furosemide 40-80mg, (cannulate)
Morphine w/antiemetic
AS - GTN sprary

Fluid balance (consider catheterise), furosemide to oral and repeat CXR.

Question 5

CXR Findings

Answer 5

Kerley B lines
Distended hilar vessels (cephalisation)
Cardiomegaly
Batwing shaped diffuse consolidation.
Pleural effusion