Pulmonary edema medical therapy: Difference between revisions
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==== Drug therapy ==== | ==== Drug therapy ==== | ||
* loop diuretics | * loop diuretics | ||
* Morphine and Its Analogues | * '''Morphine and Its Analogues''' | ||
** May be given in the early stage of the treatment in patient with severe acute heart failure, especially if they present with restlessness, dyspnea, anxiety, or chest pain<ref name="pmid18356349">{{cite journal |vauthors=Peacock WF, Hollander JE, Diercks DB, Lopatin M, Fonarow G, Emerman CL |title=Morphine and outcomes in acute decompensated heart failure: an ADHERE analysis |journal=Emerg Med J |volume=25 |issue=4 |pages=205–9 |date=April 2008 |pmid=18356349 |doi=10.1136/emj.2007.050419 |url=}}</ref> | ** May be given in the early stage of the treatment in patient with severe acute heart failure, especially if they present with restlessness, dyspnea, anxiety, or chest pain<ref name="pmid18356349">{{cite journal |vauthors=Peacock WF, Hollander JE, Diercks DB, Lopatin M, Fonarow G, Emerman CL |title=Morphine and outcomes in acute decompensated heart failure: an ADHERE analysis |journal=Emerg Med J |volume=25 |issue=4 |pages=205–9 |date=April 2008 |pmid=18356349 |doi=10.1136/emj.2007.050419 |url=}}</ref> | ||
** Relieves dyspnea and other symptoms | |||
** Bolus of morphine 2.5 – 5 mg may be administered | |||
** Respiration should be monitored | |||
** Nausea often occurs and antiemetics therapy may be necessary | |||
** Extra caution when giving morphine in following conditions: | |||
*** Hypotension | |||
*** Bradycardia | |||
*** Advanced AV block | |||
*** CO2 retention | |||
* Vasopressin Antagonists | * Vasopressin Antagonists | ||
* Vasodilators | * Vasodilators | ||
Revision as of 20:19, 6 March 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]
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Overview
Medical Therapy
Pulmonary edema classified into cardiogenic and non-cardiogenic pulmonary edema, each requires different management and has a different prognosis.[1]
Cardiogenic pulmonary edema:
The main goal of management is to alleviate symptoms and stabilize patient as well as to improve outcome.[2]
Oxygen therapy
- Administer oxygen as early as possible
- Achieve 95% arterial oxygen saturation (90% in COPD patients)
- Caution should be taken in patients with severe airway obstruction to avoid hypercapnia
Drug therapy
- loop diuretics
- Morphine and Its Analogues
- May be given in the early stage of the treatment in patient with severe acute heart failure, especially if they present with restlessness, dyspnea, anxiety, or chest pain[3]
- Relieves dyspnea and other symptoms
- Bolus of morphine 2.5 – 5 mg may be administered
- Respiration should be monitored
- Nausea often occurs and antiemetics therapy may be necessary
- Extra caution when giving morphine in following conditions:
- Hypotension
- Bradycardia
- Advanced AV block
- CO2 retention
- Vasopressin Antagonists
- Vasodilators
- Inotropic agents
- Dobutamine
- Dopamin
- Vasopressor
- Milrinone and Enoximone
- Cardiac Glycosides
References
- ↑ Murray JF (February 2011). "Pulmonary edema: pathophysiology and diagnosis". Int. J. Tuberc. Lung Dis. 15 (2): 155–60, i. PMID 21219673.
- ↑ Alwi I (July 2010). "Diagnosis and management of cardiogenic pulmonary edema". Acta Med Indones. 42 (3): 176–84. PMID 20973297.
- ↑ Peacock WF, Hollander JE, Diercks DB, Lopatin M, Fonarow G, Emerman CL (April 2008). "Morphine and outcomes in acute decompensated heart failure: an ADHERE analysis". Emerg Med J. 25 (4): 205–9. doi:10.1136/emj.2007.050419. PMID 18356349.