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Condition/Disorder Synonym

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  • Oedema

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ICD-9-CM Codes

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  • 514 Pulmonary congestion and hypostasis

  • 518.4 Acute edema of lung, unspecified

  • PT diagnoses/treatment diagnoses that may be associated with respiratory disorders

    • 786.05 Shortness of breath

    • 780.7 Malaise and fatigue

    • 786.0 Dyspnea and respiratory abnormalities

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ICD-10-CM Codes

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  • J81.0 Acute pulmonary edema

  • J81.1 Chronic pulmonary edema

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Preferred Practice Patterns1

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Key Features

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Description

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  • Fluid accumulation in the air sacs/spaces and parenchyma of the lungs

  • Respiratory failure

  • Impaired gas exchange

  • Peripheral edema

  • Shortness of breath/difficulty breathing

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Essentials of Diagnosis

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  • Sudden onset shortness of breath (dyspnea)

  • Cyanosis

  • Circulatory dysfunction

  • Coughing up blood

  • Pleural effusion

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General Considerations

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  • Injury to the lung parenchyma

  • Cardiac arrest secondary to lack of oxygen

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Demographics

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  • Elderly, usually associated with heart failure, are most affected

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Clinical Findings

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Signs and Symptoms

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  • Difficulty breathing

  • Fatigue

  • Crackles

  • Dyspnea

  • Excessive sweating

  • Anxiety

  • Third heart sound

  • Pale skin

  • Pink sputum

  • Diaphoresis

  • Increased heart rate/tachycardia

  • Cyanosis

  • Rales

  • Peripheral edema

  • Wheezing

  • Rhonchi

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Functional Implications

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  • Decreased exercise tolerance

  • Exercising at high altitude can worsen edema

  • Inability to speak secondary to shortness of breath

  • Disabling dyspnea when performing simple tasks (i.e., arm elevation to reach into cabinet)

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Possible Contributing Causes

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  • Cardiogenic verse non-cardiogenic

  • Acute myocardial infarction, heart attack

  • Seizures

  • Head trauma

  • Kidney failure

  • Electrocution

  • Ischemia

  • Congestive heart failure (CHF)

  • Valvular regurgitation

  • Mitral stenosis

  • Opiod/heroin use

  • Increased intracerebral pressure

  • Sepsis

  • Transfusion

  • Exercising at high altitude

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Differential Diagnosis

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  • CHF

  • Influenza

  • Cystic fibrosis

  • Asthma

  • Gastroesophageal reflux disease

  • Bronchiectasis

  • Kawasaki disease

  • Bronchitis

  • Upper respiratory tract infection

  • Central airway obstruction

  • Lung tumor

  • Tuberculosis

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Means of Confirmation or Diagnosis

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Laboratory Tests

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  • Blood test for electrolytes

  • Arterial blood gases

  • Lung function tests

  • Pulse oximetry

  • Auscultation

  • Percussion of the chest/lungs

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Imaging

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  • Pulmonary capillary wedge pressure

  • Pulmonary angiography

  • Chest radiograph

  • CT

  • Lung ventilation/perfusion scan

  • Echocardiogram

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Findings and Interpretation

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  • Chest x-ray demonstrates interstitial and alveolar edema

  • Crackle sound with auscultation

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Treatment

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Medication

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  • Diuretic

  • Morphine

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Referrals/Admittance

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  • For imaging, x-ray

  • To pulmonologist, for respiratory assessment

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Impairments

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  • Exercise limitation

  • Shortness of breath

  • Oxygen deprivation

  • Limited endurance capacity

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