Angioedema

<p>In this episode, Sam Ashoo, MD, interviews Prayag Mehta, MD, and Nikola Milanko, MD, two of the authors of the October 2022 Emergency Medicine Practice article on <a href="https://www.ebmedicine.net/topics/allergic-immunologic-inflammatory/emergency-medicine-angioedema" style="color:#0000FF;">Angioedema in the Emergency Department</a></p><p> </p><p>Pathophysiology: Non-pitting edema of respiratory or GI tract</p><ul><li>Histamine meditated, bradykinin mediated, or idiopathic</li><li>Acquired, inherited, or idiopathic</li><li>Do they present differently? (Urticaria, speed of onset)</li></ul><p></p><p>Histamine Mediated</p><ul><li>Most common form: 40%-70%</li><li>Can be triggered by NSAIDs</li><li>Can be induced by physical mechanism like cold, vibration</li><li>Is rash a reliable method of distinguishing the types?</li></ul><p></p><p>Bradykinin Mediated</p><ul><li>May progress slowly</li><li>Can be inherited or acquired</li><li>Common triggers include ACE inhibitors and TPA</li></ul><p></p><p>Table 1 Differential Diagnosis</p><p> </p><p>Prehospital Care</p><ul><li>Protect airway</li><li>Epi, steroids, antihistamines</li><li>Avoid CPAP</li></ul><p></p><p>ED History</p><ul><li>Figure 2: Distinguishing characteristics of histamine vs bradykinin mediated</li></ul><p></p><p>ED Exam</p><ul><li>Importance of repetitive exams</li><li>Airway examination</li><li>Laryngoscopy?</li></ul><p></p><p>Diagnostics</p><ul><li>Figure 6: Flow diagram of ED workup</li><li>Labs</li><li>Imaging</li></ul><p></p><p>Treatment</p><ul><li>Airway: Intubation</li><li>Medication</li></ul><p></p><p>Special Populations</p><ul><li>Pediatric</li><li>Pregnant/lactating patients</li></ul><p></p><p>Controversies</p><ul><li>TXA</li></ul><p></p><p>Disposition</p>