1/ 10 The most recognized form of Non-Cardiogenic pulmonary edema(NCPE) is ARDS, however the scope of NCPE is much broader with many causes. One particular cause of NCPE we encountered was due to opoid use which is explored in this #medtweetorial
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2/10 The onset of noncardiogenic pulmonary edema after opioid overdose was first described by Osler
during an autopsy in 1880
Osler W. Oedema of the left lung — morphia poisoning: Montreal General Hospital Reports Clinical and Pathological. Montreal: Dawson Bros., 1880:291.
during an autopsy in 1880
Osler W. Oedema of the left lung — morphia poisoning: Montreal General Hospital Reports Clinical and Pathological. Montreal: Dawson Bros., 1880:291.
3/10 Its presentation and clinical course was not appreciated until the 1950s-60s.
-mechanism is known to involve ⬆️ alveolar capillary permeability
-Opioid-related NCPE presents as :
dyspnea +/- pink, frothy pulmonary secretions
+ hypoxia
Other criteria is detailed below:
-mechanism is known to involve ⬆️ alveolar capillary permeability
-Opioid-related NCPE presents as :
dyspnea +/- pink, frothy pulmonary secretions
+ hypoxia
Other criteria is detailed below:
4/10 In patients presenting with opoid OD, the goal of the administration of naloxone is to restore adequate ventilation, rather than to reverse all the effects of the opioid and potentially precipitate withdrawal.
S/S of opoid OD:
⬇️mental status,
bradypnea,
hypoxemia,
miosis
S/S of opoid OD:
⬇️mental status,
bradypnea,
hypoxemia,
miosis
5/10
There is increasing literature regarding naloxone inducing noncardiogenic pulmonary edema.
Pathophys: ⬆️catecholamine surge & mediated vasoconstriction -->fluid shift into pulmonary vascular bed.
-resolution of the edema w/in 24 to 48 hrs with or without diuretic use
There is increasing literature regarding naloxone inducing noncardiogenic pulmonary edema.
Pathophys: ⬆️catecholamine surge & mediated vasoconstriction -->fluid shift into pulmonary vascular bed.
-resolution of the edema w/in 24 to 48 hrs with or without diuretic use
6/10
Concomitant cocaine use could also potentiate the catecholamine surge
journal.chestnet.org/article/S0012-…
Concomitant cocaine use could also potentiate the catecholamine surge
journal.chestnet.org/article/S0012-…
7/Another theory :
Narcan could ⬆️ inspiratory effort prior to complete opening of the glottis ➡️ excessive neg pressure within the lung, drawing in fluid from the pulmonary vasculature.
Opioid agent + naloxone combo could also be contributing to NCPE
ems1.com/drugs/articles…
Narcan could ⬆️ inspiratory effort prior to complete opening of the glottis ➡️ excessive neg pressure within the lung, drawing in fluid from the pulmonary vasculature.
Opioid agent + naloxone combo could also be contributing to NCPE
ems1.com/drugs/articles…
8/10
It it important to be able to distinguish between Cardiogenic pulmonary edema ( hydrostatic or hemodynamic edema)
and
Noncardiogenic pulmonary edema (⬆️-permeabil-ity pulmonary edema:
columbia.edu/itc/hs/medical…
It it important to be able to distinguish between Cardiogenic pulmonary edema ( hydrostatic or hemodynamic edema)
and
Noncardiogenic pulmonary edema (⬆️-permeabil-ity pulmonary edema:
columbia.edu/itc/hs/medical…
9/10
Imaging can be useful in determining CPE from NCPE CXR's with some exceptions
a) CHF: cardiomegaly (black arrow) with fluffy air-space opacities
b) NCPE: batwing opacities (arrowheads) with air bronchogram and absence of cardiomegaly
Imaging can be useful in determining CPE from NCPE CXR's with some exceptions
a) CHF: cardiomegaly (black arrow) with fluffy air-space opacities
b) NCPE: batwing opacities (arrowheads) with air bronchogram and absence of cardiomegaly
10/10
In conclusion:
In conclusion:
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