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

FOLLOW UP