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  • Oedema

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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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  • J81.0 Acute pulmonary edema
  • J81.1 Chronic pulmonary edema

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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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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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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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  • Chest x-ray demonstrates interstitial and alveolar edema
  • Crackle sound with auscultation

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Medication

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  • Diuretic
  • Morphine

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  • For imaging, x-ray
  • To pulmonologist, for respiratory assessment

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  • Exercise limitation
  • Shortness of breath
  • Oxygen deprivation
  • Limited endurance capacity

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  • Oxygen
  • Rest
  • Fluid intake
  • Smoking cessation
  • Pulmonary rehabilitation (PR) to improve exercise capacity
  • Inspiratory muscle training (IMT)
  • Exercise (aerobic, strength, flexibility, posture, breathing) to return to prior level of function

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