| ID | 82 |
|---|---|
| Name | ACUTE PULMONARY OEDEMA |
| Cause | Causes: 1. Left sided heart failure 2. Myocardial infarction 3. Severe hypertension 4. Mitral stenosis & regurgitation; aortic stenosis & cardiac aneurysms 5. Subacute bacterial endocarditis 6. Cardiac arrhythmias 7. Water and salt overload 8. Pulmonary embolus 9. Cardiac temponade 10. Cardiac myopathy 11. Left atrial myxoma |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | |
| Management | Management: 1. The patient should be sat up either in a cardiac bed or with the legs over the side of the bed to reduce pulmonary congestion. 2. O2 supplementation by mask or nasal catheter at a rate of 4-6 lit/minute. 3. Therapeutic management- i. Inj. Morphine 5-10mg i.v slowly or by i.m or s.c injection and an antiemetic such as cyclizine 50mg by i.v injection. Morphine may be repeated after 2-4 hours. Intravenous morphine should be given very cautiously only when the patients are in extreme condition. It reduces sympathetically mediated peripheral vasoconstriction but may cause respiratory depression and exacerbation of hypoxaemia and hypercapnia. ii. Inj. Frusemide 40-80mg by i.v injection. iii. Inj. Aminophylline 5mg/kg/hour. iv. Cardiac glycoside- Initially ouabain 0.5-Img i.v slowly; can be repeated 4 hourly if necessary upto 2mg in 24 hours. Then digoxin 0.125-0.5mg daily for maintenance, v. Glyceryl trinitrate 0.5mg sublingually. 4. Reassurance and careful observation. 5. After 45 minutes: a. If the condition is same- - repeat the dose of frusemide by i.v injection. - give 5mg of morphine by i.v injection, b. If the condition worse- - phlebotomy of 500ml of blood or plasmapheresis. - cuffing the limbs 6. Treatment of the causes. |
| Introduction | It is the clinical feature of left sided heart failure due to a rise in pulmonary capillary pressure overcoming the osmotic pressure of plasma proteins |
| History | |
| Etiology | |
| Clinical Features | Clinical features: 1. Severe dyspnoea with acute onset. 2. Tachycardia, diaphoresis, cyanosis. 3. Generalized pulmonary rales, rhonchi & wheezing; cough with pink frothy sputum. 4. Arterial hypoxaemia. 5. On chest radiograph- a. Lungs- i. Blurriness of vascular outlines. ii. Increased interstitial markings due to oedema and characteristic ‘butterfly pattern’ of alveolar oedema. b. Heart- i. Enlarged or normal in size depending on whether heart failure was previously present or not. |
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