What is the Emergency Department Management of Patients with Angioedema Secondary to an ACE-inhibitor?

Update to 2006 guideline reviewed and approved by the AAEM Board of Directors 4/11/2011.

Angiotensin-converting-enzyme (ACE) inhibitors are one of the most commonly prescribed antihypertensive medications worldwide. A known adverse effect of ACE-inhibitors is angioedema, characterized by the abrupt onset of non-pitting, non-pruritic swelling that involves the reticular dermis, subcutaneous, and submucosal layers. Lesions are typically asymmetric in distribution, well defined, and located in non-dependent areas. Angioedema is a potentially life-threatening condition, as laryngeal swelling can rapidly lead to complete airway obstruction and death. Since the majority of patients with the acute onset of angioedema present to an emergency department (ED), it is crucial for the emergency physician to be expert at diagnosing and evaluating patients with ACE-inhibitor angioedema.

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