Acute Pulmonary Edema

Warning:

• The PAO can be fatal (asphyxia, serious rhythm disorder) hospitalize ++.

• Treatment is symptomatic and etiologic (underlying heart disease and triggering factor).

• It is a turning during the development of heart disease.

Clinic:

– Dyspnea asphyxia often beginner night, preceded by paroxysmal nocturnal dyspnea episodes with cough, laryngeal crackles, orthopnea, chest tightness.

– Expectoration frothy, hémoptoïque, airy.

– Find signs of seriousness: tachypnea, drawing, cyanosis, impaired consciousness, slow pulse.

– Bilateral crackles sometimes going back to the heights.

– Usual Tachycardia, gallop left, functional mitral regurgitation (except mitral stenosis).

 

Additional tests at the bedside:

– ECG: regular sinus tachycardia; sometimes signs directing to a cause: Quick AF, signs of necrosis or ischemia … not disconnect the patient ++ (electrodes to 4 members).

– Chest X-ray (if performed): alveolar edema in butterfly wings, pleurisy, possible cardiomegaly.

– Arterial blood gas (if performed): shunting with hypoxemia, hypocapnia, respiratory alkalosis or early acidosis.

To behave:

– Calm the patient.

– Implementation sitting, legs dangling.

– NATISPRAY [NTG], 0.30, 2 puffs sublingual.

– Lasix [furosemide], an intravenous, 80 mg (4 bulbs).

– Oxygen mask.

– Call the ambulance for admission in ICU.

OAP “standard”:

– Turning the scope, chest X-ray.

– Oxygen 6 l / min.

– Stop negative inotropic drugs.

– Infusion for injection Lasix [furosemide] or Burinex [bumetanide] IVD according to clinical response, urine output and blood pressure.

– Supplementation potassium.

– RISORDAN IV: 2 to 5 mg / time.

– Heparin low molecular weight for prevention of thromboembolism.

– Treatment of myocardial ischemia (possibly revascularization angioplasty type), arrhythmia (slow fast ACFA), a thrust of HTA …

– Relais diuretics IV: passing per os.

– Strict salt-free regime.

OAP serious, even asphyxia:

– Anyway, resuscitation idem, more power is positive inotropic drugs.

– If hypotension, no nitrates.

– Intubation-ventilation if necessary.

– Or even use norepinephrine against drive-by intra-aortic balloon …