Pulmonary oedema

Question 1

What is pulmonary oedema?

Answer 1

fluid accumulation in the air spaces and parenchyma of the lungs.
this decrease gas exchange

Question 2

What are the 3 main causes of pulmonary oedema?

Answer 2

1. Left ventricular failure (cardiogenic)
2. Increased permeability of capillaries due to damage
3. decreased oncotic pressure due to hypoalbuminaemia in liver or renal disease.

Question 3

how does left ventricular failure lead to pulmonary oedema?

Answer 3

increase in pressure in the pulmonary arteries leading to fluid being pushed out of the blood in to the alveoli walls and spaces.
The body responds to hypoxia by vasoconstriction of the vessels increasing the blood pressure and further exacerbating pulmonary oedema

Question 4

How does pulmonary oedema lead to SOB?

Answer 4

The fluid causes the lungs to become stiff

Question 5

What are the clinical features of pulmonary oedema?

Answer 5

SOB
Orthopnoea- this is due to increased venous return to the heart when lying-->increased BP--> more fluid moves out into the parenchyma
Paroxysmal nocturnal dyspnoea
anxiety
productive cough with pink frothy sputum

Question 6

Signs of pulmonary oedema on examination

Answer 6

increase HR and RR (resp distress)
Crackles
basal creps
increased BP
Wheeze

Question 7

Signs of RVF?

Answer 7

RV heave
increased JVP
peripheral oedema

Question 8

Why would you do a D-dimer in suspected pulmonary oedema?

Answer 8

To rule out a pulmonary embolus

Question 9

How do you manage pulmonary oedema? (8 steps)

Answer 9

1. sit patient up
2. O2 (non-invasive +ve pressure to increase sats but decrease workload)
3. gain IV access
4. ABG
5. GTN every 10 mins until BP decreases
6. loop diuretic- furosemide 40-120mg slow IV injection
7. Morphine and metoclopramide- sedates patient and causes vasodilation
8. catheterise to monitor output