Pulmonary Edema:
Pulmonary edema
is considered a medical emergency and requires hospitalization. It leads to impaired gas exchange and may cause
respiratory failure. There
are non-cardiogenic causes of pulmonary edema but
in this section
we will discuss
only cardiogenic pulmonary edema. Cardiogenic pulmonary edema
is caused by an acute
increase in left ventricular pressure
due to ventricular dysfunction which leads to fluid accumulation in the pulmonary interstitium.
Signs and Symptoms
•
Increased respiratory rate
•
Cough with expectoration (pink frothy sputum)
•
Cyanosis
•
Nocturnal dyspnea
•
Rales, rhonchi, wheezin
Chest X-ray Findings
•
Prominent pulmonary vessels
•
Effusions
•
Enlarged cardiac silhouette
•
Kerley B lines
EKG is used to determine if an arrhythmia is
contributing to the development of the pul-
monary edema.
Treatment
•
Oxygen
•
Diuretic therapy
(furosemide) reduces preload
•
Morphine sulfate; side
effects include respiratory depression and rarely hypotension
•
Sitting the patient upright
•
Nitroglycerin to reduce preload
•
Digoxin if in atrial fibrillation
•
Intravenous ACE inhibitors
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