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{{Family tree/start}}
{{Family tree/start}}
{{Family tree | | | | B01 | | | |B01= Pulmonary edema treatment based on classification}}
{{Family tree | | | | B01 | | | |B01= Pulmonary edema treatment based on classification}}
{{Family tree | |,|-|-|^|-|-|.| | }}
{{Family tree | |,|-|-|^|-|-|-|-|.| }}
{{Family tree | |C01| | | | |C02|C01= Cardiogenic pulmonary edema| C02= Noncardiogenic pulmonary edema}}
{{Family tree | |C01| | | | |C02|C01= Cardiogenic pulmonary edema| C02= Noncardiogenic pulmonary edema}}
{{familytree  | |!| | | | | |!| | | }}
{{familytree  | |!| | | | ||| |!| | | }}
{{familytree  | |D01| | | | |D02| | |D01= ❑ First step is to stabilize the patient<br> by following the ABCs of [[resuscitation]],<br> that is, [[airway]], [[breathing]], and [[circulation]]<br> ❑ Any associated [[arrhythmia]]<br> or [[myocardial infarction]] should be treated appropriately<br>❑Following drugs are used:<br>❑ [[ACE-I]] or [[ARB]]<br> ❑[[Beta blocker]]s  
{{familytree  | |D01| | | | |D02| | |D01= ❑ First step is to stabilize the patient<br> by following the ABCs of [[resuscitation]],<br> that is, [[airway]], [[breathing]], and [[circulation]]<br> ❑ Any associated [[arrhythmia]]<br> or [[myocardial infarction]] should be treated appropriately<br>❑Following drugs are used:<br>❑ [[ACE-I]] or [[ARB]]<br> ❑[[Beta blocker]]s  
:❑ [[Bisoprolol]]<br> :❑[[Carvedilol]]<br>:❑Sustained release [[metoprolol succinate]]<br>PLUS ❑[[Loop diuretics]]<br>
:❑ [[Bisoprolol]]<br> :❑[[Carvedilol]]<br>:❑Sustained release [[metoprolol succinate]]<br>PLUS ❑[[Loop diuretics]]<br>
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opioid overdose<br>:❑ Naloxone is used for the reversal of symptoms<br>❑ Salicylate toxicity<br>:❑ Sodium bicarbonate is used for the treatment<br>❑ High altitude pulmonary edema treatment:<br> :❑ Oxygen therapy is the first line therapy<br> :❑ Nifedipine<br>:❑Tadalafil and Sildenafil<br>❑Anticoagulants are used for the treatment of pulmonary edema due to pulmonary embolism<br>❑Antibiotics are used to treat underlying infections }}
opioid overdose<br>:❑ Naloxone is used for the reversal of symptoms<br>❑ Salicylate toxicity<br>:❑ Sodium bicarbonate is used for the treatment<br>❑ High altitude pulmonary edema treatment:<br> :❑ Oxygen therapy is the first line therapy<br> :❑ Nifedipine<br>:❑Tadalafil and Sildenafil<br>❑Anticoagulants are used for the treatment of pulmonary edema due to pulmonary embolism<br>❑Antibiotics are used to treat underlying infections }}
{{Family tree/end}}
{{Family tree/end}}
==References==
==References==


Latest revision as of 14:06, 16 March 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]

Overview

This is my sandbox.

Image reference

Pulmonary edema
Source: Wikimedia commons


Type 1:

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pulmonary edema
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cardiogenic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-cardiogenic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
LV failure
 
Dysrthmia
 
LV hypertrophy and cardiomyopathy
 
 
 
Volume Overload
 
MI
 
LV outflow obstruction
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Direct injury to lung
 
 
 
 
 
 
 
 
 
 
 
Hematogenous injury to lung
 
 
 
 
 
 
 
 
 
 
 
Lung injury plus elevated hydrostatic pressure
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chest trauma,pulmonary contusion
 
Aspiration
 
Smoke inhalation
 
 
 
Pneumonia
 
Oxygen toxicity
 
Pulmonary embolism,reperfusion
 
 
 
 
 
 
 
 
 
 
 
High altitude pulmonary edema
 
Neurogenic pulmonary edema
 
Reexpansion pulmonary edema
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sepsis
 
Pancreatitis
 
Nonthoracic trauma
 
Multiple transfusions
 
Intravenous drug use. e.g. heroin
 
 
 
 
 
 
 
 
 
 
 
 
 
 


96 patients (174 eyes, 70% females) were included with a mean age at presentation of 30 years


 
 
Pulmonary edema treatment based on classification
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cardiogenic pulmonary edema
 
 
 
Noncardiogenic pulmonary edema
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
stabilize patient
 
 
 
 
 
 
 
 
Cause Symptom Diagnosis Treatment
1
2
3

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [4]


Abbreviations: ABG (arterial blood gas); ACE (angiotensin converting enzyme); BMI (body mass index); CBC (complete blood count); CSF (cerebrospinal fluid); CXR (chest X-ray); ECG (electrocardiogram); FEF (forced expiratory flow rate); FEV1 (forced expiratory volume); FVC (forced vital capacity); JVD (jugular vein distention); MCV (mean corpuscular volume); Plt (platelet); RV (residual volume); SIADH (syndrome of inappropriate antidiuretic hormone); TSH (thyroid stimulating hormone); Vt (tidal volume); WBC (white blood cell);

Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging Spirometry Gold standard
Pulmonary edema[1] +/- + - + + + + + + + Basal crackle Normal Respiratory alkalosis Bat wing pattern, air bronchograms ↓Vt, ↑RV Cardiac Catheterization Tachypnea
Acute Dyspnea Respiratory system Chest and Pleura,

Lower airway

Bronchiolitis[2] - - - + +/- + - - - - Wheeze and Crackles ↑WBC Normal Bronchovascular markings ↓Vt Clinical assessment Respiratory syncytial virus (RSV)
COPD exacerbation[3] - + - + + + + +/- +/- +/- Wheeze, Rhonchi, and Crackles ↑WBC, ↑RBC Respiratory alkalosis Hyperexpansion ↓ FEV1/FVC Clinical assessment Acute exacerbations of chronic bronchitis (AECB)
Lung carcinoma[4] - - + - - + + + - - Wheeze and Crackles Normal Normal Mass lesion, hilar lymphadenopathy ↓Vt, ↑RV Bronchoscopy  Paraneoplastic syndromes, such as SIADH and lambert-Eaton
Pneumonia[5] - - - + + + - - - - Wheeze, Rhonchi, and Crackles ↑WBC, neutrophilia Normal Lobar consolidation Normal Chest X-ray and CT Scan productive cough
Chronic Dyspnea Respiratory system Chest and Pleura,

Lower airway

Bronchiectasis[6] - - - + + + + + - - Rhonchi, Wheezing, Crackles ↑WBC, neutrophilia ↓O2, ↑CO2 Tram-track opacities ↑ FEV1/FVC High resolution computed tomography (HRCT) Chronic productive cough
Interstitial lung disease[7] - - - - + + + + - - Rhonchi, Wheezing, Crackles Normal ↓O2, ↑CO2 Peripheral pulmonary infiltrative opacification ↑ FEV1/FVC High resolution computed tomography (HRCT) Pneumoconiosis
Sarcoidosis[8] - - +/- - +/- + + - - - Crackles Normal ↓O2, ↑CO2 Hilar adenopathy ↑ FEV1/FVC High resolution computed tomography (HRCT) Hypercalcemia, high ACE
Alveolitis[9] - - - + + + - - - - Basal crackle ↑WBC, neutrophilia Normal  Basal reticulonodular opacification   ↑ FEV1/FVC High resolution computed tomography (HRCT) Dry cough
Cystic fibrosis[10] - - + + - +/- + + - - Rhonchi, Wheezing, Crackles Normal Metabolic alkalosis Thick-walled bronchiectasis ↓ FEF75%/FVC Sweat test Absent vas deferens
Tuberculosis[11] - - + + + + +/- - - - Rhonchi, Wheezing, Crackles ↑WBC ↓O2, ↑CO2 Patchy consolidation or poorly defined linear and nodular opacities Restrictive, obstructive, or mixed IFN-γ release assay (IGRA)

Acid-fast staining

Night sweat
Autoimmune Wegener's granulomatosis[12] - - +/- - - + - - - - Wheezing, Crackles ↓ RBC ↓O2, ↑CO2 Cavitate nodules, ground-glass opacity ↓ FEV1/FVC Biopsy demonstrating a granulomatous vasculitis Chronic rhinosinusitis
 
 
Prevention of pulmonary edema
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-cardiogenic pulmonary edema
 
Cardiogenic pulmonary edema
 
 
 
 
 
 
 
 
 
 
 
 
 
 

❑ Encourage healthy lifestyle and exercise
❑ Precautions for pulmonary edema associated with high altitude

❑ ❑ (I-A)
❑ Control obesity (I-C)
❑ (I-C)
❑ Avoid tobacco (I-C)
❑

❑
 

❑ Encourage healthy lifestyle and exercise
❑ Treat hypertension (I-A)
❑ Treat dyslipidemia (I-A)
❑ Control obesity (I-C)
❑ Treat DM (I-C)
❑ Avoid tobacco (I-C)

❑ Avoid cardiotoxic agents (I-C)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Consider additional measures in selected patients: ❑ Administer ACE-I if history of MI or ACS and reduced EF to prevent symptoms and reduce mortality (I-A), in all decreased EF to prevent symptoms (I-A)
❑ Administer beta-blockers if history of MI or ACS and reduced EF to reduce mortality (I-B), in all reduced EF to prevent symptoms (I-C)
❑ Administer statins if history of MI or ACS to prevent symptoms (I-A)

❑ Consider ICD placement to prevent sudden death if asymptomatic ischemic cardiomyopathy, > 40 days post-MI, LVEF ≤30%, on adequate medical therapy, and good 1 year survival
 
 
 



 
 
 
 
 
 
 
A01
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
B01
 
 
 
 
 
 
 
B02
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
D01
 
D02
 
D03
 
D04
 
D05


 
 
 
Pulmonary edema treatment based on classification
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cardiogenic pulmonary edema
 
 
 
 
Noncardiogenic pulmonary edema
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ First step is to stabilize the patient
by following the ABCs of resuscitation,
that is, airway, breathing, and circulation
❑ Any associated arrhythmia
or myocardial infarction should be treated appropriately
❑Following drugs are used:
❑ ACE-I or ARB
❑Beta blockers
❑ Bisoprolol
 :❑Carvedilol
:❑Sustained release metoprolol succinate
PLUS ❑Loop diuretics
❑ Starting dose:
:❑ Furosemide 20 to 40 mg, OR
:❑ Torsemide 10 to 20 mg, OR
:❑ Bumetanide 0.5 to 1 mg
❑ Monitor volume status and adjust dose
❑ No response: double oral diuretics dose rather than administer BID
❑No or minimal response despite maximal diuretic dose
then administer anotherdiuretics BID or TID PLUS
❑Aldosterone antagonist
❑Vasopressin antagonists:
❑ Conivaptan
❑Tolvaptan
❑ Type III phosphodiesterease inhibitors
❑Milrinone and enoximone
 
 
 
 
❑Treatment of the underlying cause is very important
❑ If the cause of pulmonary edema is overdose of opioid overdose
:❑ Naloxone is used for the reversal of symptoms
❑ Salicylate toxicity
:❑ Sodium bicarbonate is used for the treatment
❑ High altitude pulmonary edema treatment:
 :❑ Oxygen therapy is the first line therapy
 :❑ Nifedipine
:❑Tadalafil and Sildenafil
❑Anticoagulants are used for the treatment of pulmonary edema due to pulmonary embolism
❑Antibiotics are used to treat underlying infections
 
 

References

  1. ↑ Martindale, Jennifer L.; Noble, Vicki E.; Liteplo, Andrew (2013). "Diagnosing pulmonary edema". European Journal of Emergency Medicine. 20 (5): 356–360. doi:10.1097/MEJ.0b013e32835c2b88. ISSN 0969-9546.
  2. ↑ Holbro A, Lehmann T, Girsberger S, Stern M, Gambazzi F, Lardinois D, Heim D, Passweg JR, Tichelli A, Bubendorf L, Savic S, Hostettler K, Grendelmeier P, Halter JP, Tamm M (2013). "Lung histology predicts outcome of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation". Biol. Blood Marrow Transplant. 19 (6): 973–80. doi:10.1016/j.bbmt.2013.03.017. PMID 23562737.
  3. ↑ Qureshi H, Sharafkhaneh A, Hanania NA (2014). "Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications". Ther Adv Chronic Dis. 5 (5): 212–27. doi:10.1177/2040622314532862. PMC 4131503. PMID 25177479.
  4. ↑ Dela Cruz CS, Tanoue LT, Matthay RA (2011). "Lung cancer: epidemiology, etiology, and prevention". Clin Chest Med. 32 (4): 605–44. doi:10.1016/j.ccm.2011.09.001. PMC 3864624. PMID 22054876.
  5. ↑ Simonetti AF, Viasus D, Garcia-Vidal C, Carratalà J (2014). "Management of community-acquired pneumonia in older adults". Ther Adv Infect Dis. 2 (1): 3–16. doi:10.1177/2049936113518041. PMC 4072047. PMID 25165554.
  6. ↑ Cantin, Luce; Bankier, Alexander A.; Eisenberg, Ronald L. (2009). "Bronchiectasis". American Journal of Roentgenology. 193 (3): W158–W171. doi:10.2214/AJR.09.3053. ISSN 0361-803X.
  7. ↑ Baughman RP, Shipley RT, Loudon RG, Lower EE (1991). "Crackles in interstitial lung disease. Comparison of sarcoidosis and fibrosing alveolitis". Chest. 100 (1): 96–101. PMID 2060395.
  8. ↑ Moher D, Cole CW, Hill GB (November 1992). "Epidemiology of abdominal aortic aneurysm: the effect of differing definitions". Eur J Vasc Surg. 6 (6): 647–50. PMID 1451823.
  9. ↑ Khanna D, Clements PJ, Furst DE, Chon Y, Elashoff R, Roth MD, Sterz MG, Chung J, FitzGerald JD, Seibold JR, Varga J, Theodore A, Wigley FM, Silver RM, Steen VD, Mayes MD, Connolly MK, Fessler BJ, Rothfield NF, Mubarak K, Molitor J, Tashkin DP (February 2005). "Correlation of the degree of dyspnea with health-related quality of life, functional abilities, and diffusing capacity for carbon monoxide in patients with systemic sclerosis and active alveolitis: results from the Scleroderma Lung Study". Arthritis Rheum. 52 (2): 592–600. doi:10.1002/art.20787. PMID 15692967.
  10. ↑ Ziegler, Bruna; Rovedder, Paula Maria Eidt; Dalcin, Paulo de Tarso Roth; Menna-Barreto, Sérgio Saldanha (2009). "Padrões ventilatórios na espirometria em pacientes adolescentes e adultos com fibrose cística". Jornal Brasileiro de Pneumologia. 35 (9): 854–859. doi:10.1590/S1806-37132009000900006. ISSN 1806-3713.
  11. ↑ Campbell IA, Bah-Sow O (2006). "Pulmonary tuberculosis: diagnosis and treatment". BMJ. 332 (7551): 1194–7. doi:10.1136/bmj.332.7551.1194. PMC 1463969. PMID 16709993.
  12. ↑ Cardenas-Garcia J, Farmakiotis D, Baldovino BP, Kim P (2012). "Wegener's granulomatosis in a middle-aged woman presenting with dyspnea, rash, hemoptysis and recurrent eye complaints: a case report". J Med Case Rep. 6: 335. doi:10.1186/1752-1947-6-335. PMC 3492078. PMID 23034218.


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