New Chf/ Flash Pulmonary Edema

[Dorsky01]

Hey Guys,
So yet another one of those judgment call runs this evening.

Dispatched on Diff Breathing. Found pt in acute distress. accessory muscle use, pale diaphoretic. Ekg shows slight elevation in V2. I gave her high flow O2 IV. Pressure is only 80 Systolic. cant really hear any fluid in the lungs. Wasnt thinking CHF because of the pressure and the rapid onset. Didnt think C-Pap because i didnt hear fluid. Once at the ER. The doc says he hears rhales throughout, and her pressure shot up to 230/110. Is this normal with Flash pulmonary edema. Pt has no previous cardiac or pulmonary History.

 

[DrankTheKoolaid]

re

I had a similar patient about 3 weeks ago. 83 YO/F per patient no medical history to speak of and takes no meds. Woke at 0900 felt fine. Around 1700 began having what she called abdominal pain motioning to the left of her epigastrium. 2200 began developing shortness of breath and finally called 911 at 2300. I had an hour drive time to her through horrible mountain roads. Arrived to her in the back of BLS ambulance with NRM in place, patient pale cool wet, Labored RR 32 rales from bases to clavicles with a nagging non productive cough that would cause her to brady down to the 42 - 60 range, but mine was hypertensive from the start 180's/130's. CM showing ST rate in the 120's without ectopy with no obvious elevation/depression in I II or II. En route gave a total of 4 0.4mg NTG, initially 40mg of lasix then a second 40mg and a total of 20mg MSO4 with very very little change in distress, though patient stated was breathing better (was close to a nasal intubation so i could began suctioning secretions, but patient maintained and didnt get to tired on me). Arrived ER with 12 lead showing massive infarct. Unfortunately we don't have CPAP in our scope yet and our Medical Director is dragging his feet for some reason as this patient was the absolute perfect candidate for it.

The strange thing was the abdominal pain even though i had considered it referred cardiac pain. I didn't give ASA as i followed the CHF/PE protocols and i'm glad i hadn't because once i got her to the ED the abdominal pain turned into hematoemesis, with the doctor stating it was probably a silent MI with a GI bleed causing the pain. This turned out to be a huge factor for her further treatment as the cardiologist on call was really a a loss on how to treat her after the GI Bleed findings.

Anyways your story seem fairly typical after i did some more research on it after i had my call


Corky

 

[vquintessence]

Hey Guys,
So yet another one of those judgment call runs this evening.

Dispatched on Diff Breathing. Found pt in acute distress. accessory muscle use, pale diaphoretic. Ekg shows slight elevation in V2. I gave her high flow O2 IV. Pressure is only 80 Systolic. cant really hear any fluid in the lungs. Wasnt thinking CHF because of the pressure and the rapid onset. Didnt think C-Pap because i didnt hear fluid. Once at the ER. The doc says he hears rhales throughout, and her pressure shot up to 230/110. Is this normal with Flash pulmonary edema. Pt has no previous cardiac or pulmonary History.

Sorry if I'm coming off sounding critical but what does "can't really" mean in an assessment? "I can't really" sounds like you were unsure of yourself and didn't check further to confirm or deny your suspicion.
How many places and where did you listen to the LS? Attempted through clothing or on flesh? What are pts other pmhx, including present overall state of health?

I'll address your question with my own: Flash edema is typically provoked by AMI or toxic inhalation. With AMI as a culprit, does that narrow the area to the LV? What do you associate LV failure with? Why do you think your pt was in acute resp distress, but somehow presenting without other symptoms aside from looking like a fish out of water?

 

[daughertyemta]

It can be flash pulmonary edema. I had a similar patient. She was only 35 years old with no prev. hx. She was healthy, we got called for SHOB and pt states it feels like her lungs are filling up with fluid. We all thought it would be bs because of the age. When we got there, fire on scene states pt. was "making love" with her boyfriend when she suddendly felt like she couldn't breathe. She was coughing up a pink, tinged sputum in a bucket and you could hear rales dead in the center of her chest with lung sounds clear every where else. She had a high pressure and cardiac monitor was tachy. 12 lead was done with no significant findings. We did the standard tx, nitro and lasix. Her pressure came down and she felt a little better. We got her to the ER and she did indeed have flash pulmonary edema..The cause is still unknown but it was def. a good learning experience. So I would say yes..its ems, anything is possible hehe!