Respiratory Emergencies | Part Four | Pneumonia & Pulmonary Edema

Pneumonia: acute inflammatory condition of the lungs, Bacterial, fungal or viral, 5th leading cause of death. Group of infections due to many different agents. Disorder of ventilation due to infection of the lung parenchyma >> sometimes atelectasis.

Community acquired: not as severe
Hospital acquired: pseudomonas = gram negative bacteria

Risk factors:

  • Cigarette smokers
  • Alcoholics
  • Cold exposure (chronic hypothermia – homeless people)

Extremes of age

  • Abnormal immune systems

Assessment: typically acute fever and chills, cough, pleuritic chest pain, crackles

Management: Contagious! Airway support, O2, IV to rehydrate, watch for septic shock, reduce fever, inhaled Beta-2 agonists may be helpful.

Pulmonary Edema: filling of the lungs with fluid in the interstitial spaces, the alveoli or both. Classified as either high pressure (cardiogenic, resulting from AMI) or high permeability (noncardiogenic, hypoxemia, near-drowning, shock etc.) pulmonary edema.

Pathophysiology: result is impaired gas diffusion, particularly O2
In high pressure (cardiogenic) pulmonary edema:

  • Ischemia leads to left ventricle failure> increased ventricular pressure> pushes left atrium>pushes back into the pulmonary veins
  • Increased pulmonary capillary pressure>engorged vessels leak>accumulates in the interstitial spaces>impairs gas diffusion> alveoli rupture

In high Permeability (noncardiogenic) pulmonary edema the alveolar/capillary membrane is disrupted

  • Severe hypotension
  • Severe hypoxemia (post drowning, post cardiac arrest, severe seizure)
  • High altitude
  • Environmental toxins
  • Septic shock

Assessment: Most common presentation is Acute SHORTNESS OF BREATH. Evaluate any chest pain, cardiac history, hypoxic episode, shock, chest trauma, toxic gas inhalation, high altitude. Sign and symptoms: dyspnea, orthopnea (worse lying down), fatigue, reduced exercise capacity. Wet sounding lungs, crackles, wheezes, decreased pulse ox, and cardiac dysrhythmias. 12-lead ECG may show MA or stress.

Management: High-flow O2, keep calm, they don’t need any more adrenaline, IV if local protocol but KEEP FLOW LOW or TKO. Transport upright.

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