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FOCUSED SHIFT VIEW

Peripheral Edema

Bilateral or unilateral? Volume overload, venous disease, thrombosis, or a systemic cause?

Open full pathway
Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

  1. Check oxygenation, blood pressure, weight change, and whether swelling is unilateral or bilateral.
  2. Screen for acute heart failure, DVT/PE, cellulitis/necrotizing infection, renal failure, and liver disease.
  3. Use focused ultrasound and probability-based testing rather than treating all swelling as simple fluid retention.

2 · Escalate now if

  • Dyspnea, hypoxia, chest pain, syncope, or hypotension
  • Rapid painful unilateral swelling
  • Fever, bullae, anesthesia, or pain out of proportion
  • Oliguria, severe hypertension, or generalized edema
  • Pregnancy/postpartum with new edema plus headache, dyspnea, or hypertension

3 · Immediate workup

  • POCUS: lung B-lines, cardiac function, IVC context, compression ultrasound where trained
  • ECG and CXR when heart failure or PE is plausible

4 · Don’t miss

  • Acute heart failure / pulmonary edema
    Dyspnea, hypoxia, JVP elevation, crackles, or diffuse B-lines require an acute-heart-failure assessment.
  • DVT with pulmonary embolism
    Unilateral swelling plus chest symptoms, syncope, or hypoxia needs VTE pathway assessment.
  • Necrotizing infection / compartment syndrome
    Pain out of proportion, rapid progression, bullae, anesthesia, or systemic toxicity.

5 · Disposition lane

Admit

New heart/renal/hepatic decompensation, cellulitis requiring IV treatment, or uncertain VTE workup.

Resuscitation / specialty pathway

Pulmonary edema, PE with instability, necrotizing infection, or compartment concern.