Background Show Definition: Accumulation of blood in the pulmonary vasculature as a result of the inability of the left ventricle to pump blood forward adequately. Acute pulmonary edema, congestive heart failure and cardiogenic shock are a spectrum of diseases and should be considered and managed differently. Epidemiology:
Causes: Acute myocardial infarction (AMI) is the most common cause of APE but there are a multitude of other causes including acute valvular pathology. Pathophysiology: Our understanding of the pathophysiology of APE has changed dramatically over the last 70 years. The current model is based on the effects of neurohormones:
Immediate Management: NB: Patients with APE have extremely tenuous respiratory status. As such, early management choices (first 10 minutes) determine whether these patients have good or bad outcomes. Basics: ABCs, IV, O2, Cardiac Monitor, 12-lead EKG and POC Lung Ultrasound Breathing
Circulation
12-Lead EKG
Chest X-Ray (CXR)
Point of Care Ultrasound (POCUS)
Less Useful Treatments
Read More: Furosemide in the Treatment of Acute Pulmonary Edema (emDocs.net) References: Nava S et al. Noninvasive ventilation in cardiogenic pulmonary edema – a multicenter randomized trial. Am J Resp Crit Care Med 2003; 168: 1432-7. PMID: 12958051 Bersten AD et al. Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. NEJM 1991; 325 (26): 1825-30. PMID: 1961221 Liesching T et al. Randomized trial of bilevel versus continuous positive airway pressure for acute pulmonary edema. J Emerg Med 2014; 46(1): 130-40. PMID: 24071031 Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: The BLUE protocol. Chest 2008; 134: 117-25. PMID: 18403664 Martindale JL et al. Diagnosing pulmonary edema: lung ultrasound versus chest radiography. Eur J Emerge Med 2012. PMID: 23263648 Laursen CB et al. Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial. Lancet Respir Med 2014; 2: 638-46. PMID: 24998674 Bussmann W, Schupp D. Effect of sublingual nitroglycerin in emergency treatment of severe pulmonary edema. Am J Card 1978; 41: 931-936. PMID: 417614 Hamilton RJ et al. Rapid Improvement of acute pulmonary edema with sublingual captopril. Acad Emerg Med 1996; 3: 205-12. PMID: 8673775 Haude M et al. Sublingual administration of captopril versus nitroglycerin in patients with severe congestive heart failure. Intl J Card 1990; 27: 351-9. PMID: 2112516 Peacock WF et al. Morphine and Outcomes in Acute Decompensated Heart Failure: An ADHERE Analysis. Emerg Med J 2008; 25: 205 – 209. PMID: 18356349 Zile MR et al. Transition from chronic compensated to acute decompensated heart failure: pathophysiological insights obtained from continuous monitoring of intracardiac pressures. Circulation 2008; 118: 1433-41. PMID: 18794390 Chaudhry S et al. Patterns of weight change preceding hospitalization for heart failure. Circulation 2007;116:1549 –54. PMID: 17846286 Fallick C et al. Sympathetically mediated changes in capacitance: redistribution of the venous reservoir as a cause of decompensation. Circ Heart Fail 2011; 4: 669-75. PMID: 21934091 Marik PE, Flemmer M. Narrative review: the management of acute decompensated heart failure. J Intensive Care Med 2012; 27: 343-53. PMID: 21616957 What happens to the lungs during pulmonary edema?Pulmonary edema is a condition caused by too much fluid in the lungs. This fluid collects in the many air sacs in the lungs, making it difficult to breathe. In most cases, heart problems cause pulmonary edema.
What is the most common cause of acute pulmonary oedema?The most common causes of acute pulmonary oedema include myocardial ischaemia, arrhythmias (e.g. atrial fibrillation), acute valvular dysfunction and fluid overload. Other causes include pulmonary embolus, anaemia and renal artery stenosis.
Can pulmonary edema cause acute respiratory failure?Pulmonary edema can be a result of several conditions, including congestive heart failure, pneumonia, and sepsis. In addition to causing symptoms such as cough, wheezing, chest pain, and excessive sweating, pulmonary edema can result in severe breathing difficulties and may be fatal without proper treatment.
What is the main complaint of patient with acute pulmonary edema?Acute pulmonary edema will have[11]: Excessive shortness of breath worsening on exertion or lying down. A feeling of the sinking of heart and drowning/anxiety worsening on lying down. Gasping for breath.
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