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Medical: 5 Pulmonary: 1

          • (e)

            Septic shock

        • (2)

          Disrupted membranes leak fluid into the interstitial space

        • (3)

          Widened interstitial space impairs diffusion

    • 5.

      Assessment findings

      • a)

        High pressure (cardiogenic)

        • (1)

          Refer to cardiology unit

      • b)

        High permeability (non-cardiogenic)

        • (1)

          History of associated factors

          • (a)

            Hypoxic episode

          • (b)

            Shock (hypovolemic, septic, or neurogenic)

          • (c)

            Chest trauma

          • (d)

            Recent acute inhalation of toxic gases or particles

          • (e)

            Recent ascent to high altitude without climatizing

        • (2)

          Dyspnea

        • (3)

          Orthopnea

        • (4)

          Fatigue

        • (5)

          Reduced exercise capacity

        • (6)

          Pulmonary rales, particularly in severe cases

      • c)

        Diagnostic testing

        • (1)

          Pulse oximetry

    • 6.

      Management

      • a)

        High pressure (cardiogenic)

        • (1)

          Refer to cardiology unit

      • b)

        High permeability (non-cardiogenic)

        • (1)

          Airway and ventilation

        • (2)

          Intubation as necessary

          • (a)

            Assisted ventilation may be required

          • (b)

            High flow oxygen

      • c)

        Circulation

        • (1)

          Avoid fluid excess

        • (2)

          Monitor IV flow rates carefully

      • d)

        Pharmacological

        • (1)

          Diuretics may be considered in severe cases, but are not usually appropriate since the etiology is NOT high pressure in the pulmonary capillary bed

        • (2)

          Corticosteroid to stabilize pulmonary capillary and alveolar walls

      • e)

        Non-pharmacological

        • (1)

          Position the patient in an upright position with legs dangling

        • (2)

          Rapid removal from any environmental toxins

        • (3)

          Rapid descent in altitude if high altitude pulmonary edema (HAPE) is suspected

      • f)

        Transport decisions

        • (1)

          Appropriate mode

        • (2)

          Appropriate facility

      • g)

        Psychological support/ communication strategies

  • E.

    Pulmonary thromboembolism

    • 1.

      Epidemiology

      • a)

        Incidence

        • (1)

          Responsible for 50,000 death annually

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───────────────────────── United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum

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