Angioedema in the Emergency Department: An Evidence-Based Update (Pharmacology CME)

Show Notes

Pathophysiology: Non-pitting edema of respiratory or GI tract.

• Histamine meditated , bradykinin mediated or idiopathic
• Acquired, inherited, or idiopathic
• Do they present differently ? (urticaria, speed of onset)

Histamine Mediated

• Most common form. 40-70%
• Can be triggered by NSAIDs
• Can be induced by physical mechanism like cold, vibration
• Is rash a reliable method of distinguishing the types?

Bradykinin Mediated

• May progress slowly
• Can be inherited or acquired
• Common triggers include ACE inhibitors and TPA

Table 1 Differential Diagnosis

Prehospital Care

• Protect Airway
• Epi, Steroids, Antihistamines
• Avoid CPAP

ED History

• Figure 2 - distinguishing characteristics of Histamine vs Bradyknin mediated

ED Exam

• Importance of repetitive exams
• Airway examination
• Laryngoscopy?

Diagnostics

• Figure 6 flow diagram of ED workup
• Labs
• Imaging

Treatment

• Airway - intubation
• Medication

Special Populations

• Pediatric
• Pregnant / Lactating patients

Controversies

• TXA

Disposition