Pulmonary oedema

This is a very frightening, life-threatening emergency characterised by extreme breathlessness

Clinical features:

Patients with alveolar oedema are:

• Acutely breathless
• Wheezing
• Anxious
• Perspiring profusely
• Cough, productive of frothy, blood-tinged (pink) sputum, which can be copious
• Tachypnoea
• Peripheral circulatory shutdown
• Tachycardia
• Raised JVP
• Gallop rhythm
• Crackles and wheeze are heard throughout the chest

CXR shows:

• Diffuse haziness
• Kerley B lines (of interstitial oedema)

Treatment:

• Sit the patient up
• Give 60% O₂ (unless there is coexisting chronic hypercapnia due to longstanding respiratory failure)
• IV diuretic therapy with frusemide or bumetanide is given
• Morphine (10-20mg IV) together with an antiemetic (e.g. metoclopramide 10mg IV or cyclizine 50mg IV) is given:
• This sedates the patient and causes systemic vasodilatation – it must be avoided if the systolic BP is <90mmHg

• Venodilators (e.g. GTN) may produce prompt relief by reducing preload
• Aminophylline (250-500mg or 5mg/kg IV) is infused over 10 minutes:
• Is a PDE inhibitor that causes bronchodilation, vasodilatation and increased cardiac contractility
• It must be GIVEN SLOWLY due to the risk of precipitating ventricular arrhythmias
• It is now only used when bronchospasm is present