Respiratory: Pulmonary Oedema Flashcards
What is pulmonary oedema?
Accumulation of fluid in the parenchyma and air spaces of the lungs.
Most commonly as a result of heart failure and/or fluid overload.
Typical symptoms of pulmonary oedema?
1) SOB
2) Pink frothy sputum
Typical signs of pulmonary oedema?
1) tachypnoea
2) decreased O2 sats
3) Raised JVP
An ABCDE approach should be used in severe pulmonary oedema.
Describe the assessment in ‘airway’
1) Can the patient talk?
If no:
a) Look for signs of airway compromise e.g. cyanosis, see-saw breathing, use of accessory muscles, diminished breath sounds and added sounds.
b) Open the mouth and inspect: obstructions e.g. secretions, foreign object
Give some causes of airway compromise
1) inhaled foreign body
2) blood in airway: e.g. epistaxis, haematemesis and trauma
3) vomit/secretions in airway
4) soft tissue swelling: anaphylaxis and infection (e.g. quinsy, necrotising fasciitis).
5) local mass effect: e.g. tumours
6) laryngospasm: asthma, gastro-oesophageal reflux disease (GORD) and intubation
7) depressed level of consciousness e.g. opioid overdose, head injury, stroke
Discuss possible interventions in ‘airway’
1) Head-tilt chin-lift manoeuvre
2) Jaw thrust
3) Oropharyngeal airway (Guedel)
4) Nasopharyngeal airway (NPA)
5) Others e.g. anaphylaxis management
6) CPR
When would a jaw thrust be indicated over a head-tilt chin-lift manoeuvre?
If the patient is suspected to have suffered significant trauma with potential spinal involvement.
Who should nasopharyngeal airways (NPA) not be used in?
Patients who may have sustained a skull base fracture (due to the small but life-threatening risk of entering the cranial vault with the NPA).
Which type of airway adjuct is better tolerated in patients who are partly or fully conscious?
Nasopharyngeal airway (NPA)
Discuss assessment in ‘breathing’
1) RR
2) O2 sats
3) Inspection: respiratory distress e.g. the use of accessory muscles and cyanosis
4) Palpation:
- trachea position
- apex beat
- chest expansion
5) auscultation of lung fields
6) percussion
What RR is typically seen in pulmonary oedema?
Tachypnoea: indicates significant respiratory compromise.
what does bradypnoea indicate in ABCDE?
Bradypnoea in the context of hypoxia is a sign of impending respiratory failure and the need for urgent critical care review.
How does severe pulmonary oedema typically affect O2 sats?
Hypoxaemia is a typical clinical feature of pulmonary oedema.
What can cause a displaced apex beat?
1) large pleural effusion
2) tension pneumothorax
3) right ventricular hypertrophy
What auscultation findings can be seen in pulmonary oedema?
1) Reduced breath sounds and/or coarse crackles
2) Wheeze (‘cardiac asthma’)
Discuss investigations in ‘breathing’
1) ABG
2) CXR
Typical ABG findings in pulmonary oedema?
low PaO2 and low PaCO2
What does a normal or raised PaCO2 indicate in pulmonary oedema?
Concerning as it indicates that the patient is tiring and failing to ventilate effectively.
What may be seen on a CXR in pulmonary oedema?
1) bilateral peri-hilar shadowing
2) blunting of costophrenic angles
3) fluid in fissures (e.g. right horizontal fissure)
4) Kerley B lines
Discuss interventions in ‘breathing’
1) O2: 15 litre non-rebreathe
2) Continuous positive airway pressure (CPAP)
3) CPR
Who is CPAP considered in in pulmonary oedema??
Should be considered for patients who do not improve after supplemental oxygen and intravenous diuretics.
What should make sure to do after every intervention in ABCDE?
Reassess
Discuss assessment in ‘circulation’
1) pulse
2) BP
3) capillary refill time
4) fluid status assessment
5) auscultation of heart sounds
Typical HR finding in pulmonary oedema?
Tachycardia
