Acute Pulmonary Edema

ACUTE PULMONARY EDEMA CHIEF COMPLAINTS Acute pulmonary edema HPI SYMPTOM LIST •Dyspnea •Tachypnea •Orthopnea •Tachycardia •Hypertension •Thoracic oppression •Cold extremities with cyanosis or not •Cough o Frothy /Pink sputum •Extensive use of accessory muscles of respiration •Moist rales o With / without wheezing SEVERITY • • • • • • • • •

Mild Moderate Severe Absent Normal Increased Decreased Stable No significant change from prior visit

HISTORY (PMFSH) PAST MEDICAL HISTORY •Mitral stenosis •Atrial myxoma

•Thrombosis of a prosthetic valve •Cor triatriatum •Rheumatic fever •Congestive heart failure (CHF) •Cardiomyopathy •Acute MI or ischemia •LV diastolic dysfunction •Nonischemic acute mitral regurgitation •Aortic regurgitation •Endocarditis •Aortic dissection •Constrictive pericarditis •Pericardial tamponade •Myocardial contusion •Hemodialysis-dependent renal failure •Aortic stenosis •Hypertrophic cardiomyopathy •Hypertension FAMILY HISTORY •Hypertension •Cardiac diseases •Diabetes •Renal disorders ALLERGIES Drugs____ Environment SOCIAL HISTORY Habits •Alcohol •Tobacco •Drugs Occupation___ ROS

PHYSICAL EXAMINATION SPECIFIC DATA LIKE GRADING ETC TESTS TO BE ORDERED •Blood tests o CBC with differential count o Electrolytes o Serum Creatinine o Blood Urea o Liver enzymes o C-reactive protein o Complete blood count o PT o aPTT o B-type natriuretic peptide (BNP) o BUN o Serum protein concentration •Urinalysis and microscopic examination of urine •Room air arterial blood gas concentrations o PO2 and PCO2 •Chest X-ray films: PA and Lateral •ECG: •Right heart catheterization •2D-echo •Transesophageal echocardiography (TEE) •Blood cultures •Pulmonary function tests •Other Tests o Arterial blood gas analysis o Pulse oximetry o NT-proBNP test o BNP test ASSESSMENT/PLAN: INSTRUCTIONS/EDUCATION Further Inpatient Care • •

Monitor cardiac enzyme levels Monitor continuous ECG

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Intra-aortic balloon pumping

Patient Education • • • • • • • • •

Control blood pressure Watch blood cholesterol Don't smoke Eat a heart-healthy diet (Fish -omega-3 fatty acids, fruits and vegetables) Limit salt Exercise regularly Maintain a healthy weight Get enough folic acid (folate) Manage stress

MEDICATION o o o o o o o o o o o o o o o o o o o o o

Nitroglycerin Furosemide Bumetanide Ethacrynic acid Torsemide Nitroprusside Dobutamine Dopamine Norepinephrine Milrinone Enalapril Ramipril Quinapril Perindopril Lisinopril Benazepril Captopril Morfine Naloxone Digoxin Inhaled beta-adrenergic agonists / Aminophylin IV

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