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Pulmonary Edema, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

Imbalance in Starling forces causes an accumulation of alveolar fluid secondary to leakage from pulmonary capillaries into the interstitium and alveoli of the lungs. 
  • Cardiogenic:

    • Abno...

Diagnosis

Signs and Symptoms

History

  • Risk factors:

    • Prior CHF diagnosis

    • History of coronary artery disease or myocardial infarction

    • Diabetes

    • Severe systemic illness

  • Symptoms:

    • Dyspnea on exertion progressing to...

Treatment

Pre-Hospital

  • IV access

  • Supplemental oxygen

  • 100% nonrebreather mask

  • Cardiac monitor

  • Pulse oximetry

  • Sublingual nitrates

  • If bag valve mask is needed, should use PEEP valve if available

  • Endotracheal int...

Follow-Up

Disposition

Admission Criteria

  • ICU:

    • Positive-pressure ventilation

    • Inotropic support

    • Acute cardiac ischemia or infarction

    • ARDS

  • Monitored unit:

    • New-onset pulmonary edema

    • Electrocardiographic changes

    • Pat...

Pearls and Pitfalls

  • Nitrates, SL and IV, are 1st-line therapy to reduce preload.

  • BNP can reliably differentiate between AHF syndromes and other causes of dyspnea.

  • AHF chest radiography findings can be a...

Additional Reading

  • Heart Failure Society of America, Lindenfeld J, Albert  NM, et al. HFSA2010 Comprehensive Heart Failure Practice Guideline. J Card Fail.  2010;16(6):e1–e194.

  • Jois-Bilowich  P, D...

Codes

ICD9

  • 428.1 Left heart failure

  • 514 Pulmonary congestion and hypostasis

  • 518.82 Other pulmonary insufficiency, not elsewhere classified

ICD10

  • I50.1 Left ventricular failure

  • J80 Acute respiratory distress...

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