Angioedema

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 Angioedema in the Emergency Department (https://www.ebmedicine.net/topics/allergic-immunologic-inflammatory/emergency-medicine-angioedema) 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 TPATable 1 Differential Diagnosis Prehospital Care* Protect airway* Epi, steroids, antihistamines* Avoid CPAPED History* Figure 2: Distinguishing characteristics of histamine vs bradykinin mediatedED Exam* Importance of repetitive exams* Airway examination* Laryngoscopy?Diagnostics* Figure 6: Flow diagram of ED workup* Labs* ImagingTreatment* Airway: Intubation* MedicationSpecial Populations* Pediatric* Pregnant/lactating patientsControversies* TXADisposition