protocols/edema.json

{
  "condition": "Pulmonary Edema",
  "icd10": "J81",
  "source": "WHO Clinical Guidelines / ESC Heart Failure Guidelines 2023",
  "description": "Fluid accumulation in the lungs visible on chest X-ray as interstitial or alveolar opacities, Kerley B lines, peribronchial cuffing, or butterfly pattern",
  "classification": {
    "mild": {
      "criteria": [
        "Interstitial edema: Kerley B lines, peribronchial cuffing",
        "Upper lobe pulmonary venous distension (cephalization)",
        "Mild dyspnea on exertion only"
      ],
      "label": "Mild pulmonary edema — adjust medications"
    },
    "moderate": {
      "criteria": [
        "Alveolar edema: bilateral patchy opacities",
        "Bilateral pleural effusions",
        "Dyspnea at rest when supine (orthopnea)",
        "SpO2 90-94%"
      ],
      "label": "Moderate pulmonary edema — urgent treatment"
    },
    "severe": {
      "criteria": [
        "Dense bilateral alveolar opacification (butterfly/bat wing pattern)",
        "Severe respiratory distress",
        "SpO2 <90%",
        "Frothy pink sputum",
        "Unable to lie flat"
      ],
      "label": "Acute pulmonary edema — emergency"
    }
  },
  "common_causes": [
    "Congestive heart failure (most common)",
    "Acute myocardial infarction",
    "Hypertensive emergency",
    "Valvular heart disease",
    "Fluid overload (renal failure, iatrogenic)",
    "ARDS (non-cardiogenic)",
    "High altitude pulmonary edema (HAPE)"
  ],
  "treatment": {
    "mild": {
      "setting": "outpatient / primary care",
      "actions": [
        "Optimize heart failure medications",
        "Sodium restriction <2g/day",
        "Fluid restriction 1.5L/day",
        "Daily weight monitoring (alert if >1kg/day gain)",
        "Follow-up in 1-2 weeks"
      ],
      "medications": [
        {
          "drug": "Furosemide",
          "dose": "20-40mg",
          "frequency": "once daily",
          "route": "oral",
          "class": "Loop diuretic"
        },
        {
          "drug": "Enalapril",
          "dose": "5-20mg",
          "frequency": "twice daily",
          "route": "oral",
          "class": "ACE inhibitor"
        }
      ]
    },
    "moderate": {
      "setting": "hospital",
      "actions": [
        "Sit patient upright (reduces preload)",
        "Oxygen via face mask to maintain SpO2 >=94%",
        "IV diuretics",
        "Continuous monitoring of vitals and urine output",
        "Identify and treat precipitant (infection, arrhythmia, non-compliance)"
      ],
      "medications": [
        {
          "drug": "Furosemide",
          "dose": "40-80mg",
          "frequency": "stat, repeat in 2h if needed",
          "route": "IV",
          "note": "Monitor urine output, target >0.5ml/kg/h"
        },
        {
          "drug": "Glyceryl trinitrate (GTN)",
          "dose": "0.5mg sublingual or 10-200mcg/min IV",
          "indication": "If SBP >110mmHg",
          "note": "Reduces preload"
        }
      ]
    },
    "severe": {
      "setting": "emergency / ICU",
      "actions": [
        "Position: sitting upright, legs dangling",
        "High-flow oxygen or non-invasive ventilation (CPAP/BiPAP)",
        "IV furosemide 80-120mg stat",
        "GTN infusion if blood pressure allows",
        "Consider morphine 2-4mg IV for distress (caution: respiratory depression)",
        "Urgent echocardiography if available",
        "Intubation if no response to NIV"
      ]
    }
  },
  "referral": {
    "immediate": [
      "Acute pulmonary edema with SpO2 <90%",
      "Cardiogenic shock (hypotension + pulmonary edema)",
      "New onset pulmonary edema without known heart disease",
      "No response to initial IV diuretics within 1 hour"
    ],
    "within_24h": [
      "Recurrent episodes despite medication compliance",
      "Need for echocardiography to guide management",
      "Suspected non-cardiogenic cause (ARDS)"
    ]
  }
}