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Pulmonary Edema
Pulmonary Edema
Pulmonary Edema
Objectives:
CHF
Hypertension
B. Non-cardiogenic
o May occur after upper airway obstruction, intravenous
fluid overload, neurogenic causes (seizures, head
trauma, strangulation, electrocution).
Alveolar
Infection
Other/unknown
Arteriovenous malformation
Sign & Symptoms
Difficulty, Shortness of breathing
Coughing up blood
Excessive sweating
Anxiety
Pale skin
Wheezing
Cyanosis
(bluish discoloration of the skin due to poor blood circulation , lack of O2)
A classic sign of pulmonary edema is the
production of pink frothy sputum.
If left untreated, it can lead to coma and even
death, in general, due to its main complication of
hypoxia.
Other symptoms:
Paroxysmal nocturnal dyspnea (episodes of severe
sudden breathlessness at night).
Orthopnea (inability to lie down flat due to
breathlessness).
Pathophysiology
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Treatment of Pulmonary Edema, Introduction
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Treatment of Pulmonary Edema, Introduction
1) The circulation
2) Gas exchange
3) Lung mechanics
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Treatment of Acute Pulmonary Edema
1] Support of Oxygenation and Ventilation for
a
patient with acute cardiogenic pulmonary
edema generally have an identifiable
cause of acute left venticular failure Such
as
A) Arrhythmia
B) Ischemia/ infarction
C) Myocardial decompensation
These can be treated rapidly with
improvement in Gas exchange
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Treatment of Acute Pulmonary Edema
1] Oxygen therapy :
Support of oxygenation is essential to ensure a
dequate oxygen delivery to the peripheral
tissues including the heart .
Oxygen is given by mask and start with high
concentration to keep the Oxygen saturation
above 90 %
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TREATMENT OF ACUTE PULMONARY EDEMA
2] Reduction of Preload :
Formost cases of pulmonary edema, the quantity of
extravascular lung water is related to the intravascular
volume status
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Treatment of Acute Pulmonary Edema
A) Diuretics :
The loop diuretics is preferred (Why?)
Examples of loop diuretics:
1) Frusemide
2) Bumetanide
3) Torsemide
N.B
The ascending loop of Henle has active reabsorbtion of
more than 35% of the filtered Na
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Frusemide
PHARMACOLOGIC CATEGORY:
Diuretic, Loop
DOSING: ADULTS
I.M., I.V.: 20-40 mg/dose, may be repeated in 1-2 hours as
needed
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Frusemide
Hemodynamic effects By reducing
intravascular volume, diuresis will eventually
lower central venous and pulmonary capillary
wedge pressures.
Adverse effects :
a. Hyperuricemia
b. Acute hypovolemia
c. potassium depletion
e. hypomagnesemia
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Treatment of Acute Pulmonary Edema
B) Vasodilator therapy :
Patients with acute cardiogenic pulmonary
edema are often treated with vasodilators in
an attempt to reduce preload and pulmonary
capillary wedge pressure
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Treatment of Acute Pulmonary Edema
4] Angiotensin-Converting Enzyme
Inhibitors:
These drugs reduce both the
afterload as well as the preload.
They work by inhibiting angiotensin
II production which is a potent
vasoconstrictor and this leads to
vasodilatation
example :
Captopril
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Treatment of Acute Pulmonary Edema
5] Digitalis Glycosides :
It has positive inotropic action ..(rarely used
nowadays)
It is useful for control of ventricular rate in
patient with rapid atrial fibrillation .
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Treatment of Acute Pulmonary Edema
If atrial fbrilation is the cause for the pulmonary
edema or if the ventricular rate is fast, then a
drug to control the rate is recommonded :
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Treatment of Acute Pulmonary Edema
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