Emergency & Critical Medicine » Common Emergencies

Acute pulmonary oedema

The causes of acute pulmonary oedema are reduced systolic function of the left ventricle (infarction, ischaemia or acute mitral regurgitation), diastolic dysfunction (hypertension) - Acute left ventricular failure (ischaemia, infarction, hypertension, aggravation of chronic failure) or valvular failures results in elevated pulmonary capillary pressure and consequent alveolar oedema. Toxins, pneumonias, aspirations and pancreatitis may increase the permeability of alveolar membranes, resulting in adult respiratory distress syndrome (ARDS). Atrial fibrillation and other tachyarrhythmia's can also precipitate pulmonary edema. The patient presents with severe dyspnoea, cough, tachypnoea, anxiety, fear and confusion. On examination cyanosis, pallor and bilateral basal rales may be present. Patient is given propped up position, Inj morphine and oxygen via mask. The drugs of choice are nitrate in infarction, diuretic in aggravation of chronic heart failure and digitalis and/or a beta-blocker in atrial fibrillation or supraventricular tachycardia.

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