1) Pulmonary edema is the collection of fluid in the lungs which can be caused by smoke inhalation, head trauma, shock, or high altitude ascents. 2) It presents with shortness of breath, tachypnea, anxiety, and other symptoms. Physical exam reveals fine crackles and other signs. 3) Pulmonary edema can be cardiogenic from heart failure or non-cardiogenic from other causes like smoking. Treatment involves oxygen, diuretics, and other measures to reduce fluid buildup and relieve symptoms.

1. PULMONARY
OEDEMA
MS/00020/018
MBChB V

2. INTRODUCTION
• Collection of fluid in the lung
• May be due to - smoke and other noxious gas inhalation
Acute traumatic brain injury
Intracranial haemorrhage
Shock, from any cause ie ARDS
Ascents to high altitude

3. mechanisms
• Imbalanced starling forces pulmonary capillary pressure negative
interstitial pressure, decreased plasma oncotic pressure
• Damage to the alveolar capillary barrier
• Lymphatic obstruction
• Idiopathic

4. Presentation
a) Rapidly increasing shortness of breath, which is worse on lying down
b) Tachypnea and labored breathing (stiff waterlogged lungs)
c) Pallor and sweating (characteristic)
d) Tachycardia
e) Anxiety and distress
f) Depression of consciousness

5. Physical exam
• Pt may be sitting upright, has hunger for breath, gasping
• May be diaphoretic, confused and agitated and anxious
• Hypertension is often present coz of hyper adrenergic state
• On auscultation, fine crepitant rales

6. types
cardiogenic
• Heart failure
• Fluid overload
• Myocardial infections
Non cardiogenic
• Smoking
• Head trauma
• Sepsis
• Drowning
• Acute lung reexpansion

7. Investigations
• Arterial blood gases will show a
variable degree of hypoxia, hypercapnia
and acidosis.
• B-type natriuretic peptide
(BNP)- shows ventricular
dysfunction

8. • Widened vascular markings in the upper lung fields
as a result of diversion of blood (upper lobe
diversion)
• • Air bronchogram
• • A widened mediastinum with spreading (bat’s
wing) shadows
• • Horizontal lines in the lower lobes (Kerley B lines)
• • Small pleural effusions
• • Cotton-wool shadows throughout the lung fields
• • Cardiomegaly

9. MGT
• Sit the patient up, with the legs dependent if possible.
• Give a high-concentration of oxygen by mask or via a continuous positive airway pressure
(CPAP) circuit at 5 cmH2O pressure initially
• Establish IV access.
• Start monitoring SaO2, ECG and BP.
• Request a CXR and ECG.
• Arterial blood gases may be taken, but, unless the results are instantly available, they are unlikely
to affect initial treatment.
• Give IV diamorphine 2.5–5 mg with IV prochlorperazine 12.5 mg to relieve distress and to
start venodilatation.

10. • If the patient has a history of fluid retention (CCF), give IV furosemide 1–2
mg/kg and consider the need for a urinary catheter.
• Start nitrate therapy to further reduce venous return
• Inotropes such as dobutamine are indicated in low output states (forward
failure)
• When the clinical picture is dominated by wheezing (cardiac asthma),
nebulised salbutamol may be given
• Conventional positive-pressure ventilation (IPPV) may be required in a rapidly
deteriorating patient.

11. CPAP and BiPAP
• In LVF, CPAP and BiPAP may help to alleviate respiratory distress and improve
some metabolic parameters to a limited extent
• Both are best used very selectively in acute cardiogenic pulmonary oedema.

12. DDX
a) ARDS
b) Asthma
c) Bacterial pneumonia,
d) Viral pneumonia
e) Cardiogenic shock
f) COPD
g) MI,

13. • THANK YOU