The Internet Book of Critical Care Podcast
IBCC Episode 48 Angioedema
Aug 1, 2019
The podcast covers the challenges of diagnosing and managing angioedema, especially in relation to airway protection. It distinguishes between histamine-mediated and bradykinin-mediated angioedema, and discusses the differences in triggers, symptoms, and treatment responses. The speakers emphasize the importance of quickly identifying and treating angioedema, providing recommendations for different scenarios. They also delve into the mechanisms and management of bradykinin-induced angioedema, proposing tranexamic acid and C1 inhibitor concentrate as potential treatments. The chapter concludes with a discussion on the management of angioedema and airway swelling, emphasizing the need for individualized treatment and monitoring.
28:29
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Quick takeaways
- Differentiating between histamine-mediated and bradykinin-mediated angioedema is crucial for determining appropriate treatment.
- Directly inspecting the airway using a nasopharyngeal flexible scope or a CT scan of the neck can aid in diagnosing angioedema.
Deep dives
Overview of Angioedema
Angioedema can cause a variety of symptoms, including GI symptoms and mimicking acute abdomen. However, the main concern is airway protection and asphyxiation. Critical care is crucial in managing these cases. The distinction between histamine-mediated and bradykinin-mediated angioedema is important because they require different approaches. Histamine-mediated angioedema is typically associated with allergic triggers, rapid onset, and response to antihistamines, epinephrine, and steroids. On the other hand, bradykinin-mediated angioedema, often induced by ACE inhibitors or ARBs, has a slower progression, may be focal or asymmetric, and is unresponsive to antihistamines, steroids, and epinephrine.
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