Acute Pulmonary Oedema(APO)

Posted: November 7, 2010 by smarinz7 in A & E

Def: acute,severe LV failure with pulmonary venous hypertension and alveolar flooding; usually as a secondary to other dss.

*suspected in pt had history of CVD.

Sx

  • Extreme dyspnea
  • Cough producing blood tinged sputum (pink color)
  • Diaphoresis(profuse sweating)
  • Cyanosis,pallor.
  • Paroxysmal nocturnal dyspnea (PND): pt need to use pillow to sleep.
  • Crackles heard all the time.

*In pneumonia,crackles heard at the peak of inspiration.

Pathogenesis

LV failure—heart fail to pump—blood pooling in pulmonary circ—plasma moves frm pulmonary capillaries into interstitial spaces n alveoli—APO

Etio:

  • CHF
  • Kidney failure
  • ACS
  • HT
  • Valvular disorder.

Dx

  • CXR – increase fluid in lung
  • ECG – to find the etiology
  • Serum BNP(brain natriuteric peptide)

–          BNP is secreted by heart ventricle in response to excessive stretching of cardiomyocytes.

–          >100picogram per ml indicates CHF.

  • ABG

Tx

  • O2  100% – nonrebreather mask,upright position.
  • Furosemide 1mg/kg IV
  • Nitroglycerin 0.4mg SL(5min) followed by IV drop 10-20µg/min
  • Morphine 1-5mg IV

Additional(etiological tx)

  • PCI
  • Digoxin

Emergency measures:

  • A – airway

–          Max 3L/hr nasal prong(s/e: septal damage)

–          Max 5L/hr mask

–          Max HFM 8L/hr

–          In peads,max 2L /hr

  • B – breathing in upright position
  • C- circulation (BP checking TRO shock)

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