pulmonary oedema

Question 1

what is the management of acute pulmonary oedema?

Answer 1

high flow oxygen
2.5-5mg morphine (usually 5, only 2.5 if frail)
10mg metoclopramide IV
40-80mg furosemide IV
stop fluids
give GTN spray if BP >90systolic (if lower BP will plummet)

DO NOT give cyclizine bc it worsens ventricular function

Question 2

What are the two general causes of pulmonary oedema?

Answer 2

Haemodynamic ( hydrostatic pressure)

Due to cellular injury:
-Alveolar lining cells
-Alveolar endothelium
This can be Localised – pneumonia or Generalised – adult respiratory distress syndrome (ARDS)

Question 3

What are the two causes of adult respiratory distress syndrome?

Answer 3

Diffuse alveolar damage syndrome (DADS)

Shock lung
Causes include sepsis, diffuse infection (virus, mycoplasma), severe trauma, oxygen

Question 4

Describe the pathogenesis of ARDS?

Answer 4

Injury (eg bacterial endotoxin):

• Infiltration of inflammatory cells
• Cytokines
• Oxygen free radicals
• Injury to cell membranes

Leads to :
Fibrinous exudate lining alveolar walls (hyaline membranes)
Cellular regeneration
Inflammation

Question 5

What does ARDS result in?

Answer 5

Death
Resolution
Fibrosis (chronic restrictive lung disease