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Monday, December 28, 2015

Pulmonary Edema

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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