Angioedema

EMplify by EB Medicine

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

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 bradykinin 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