Airway

Recognizing acute pulmonary edema

Waking up feeling smothered when lying flat ( orthopnea ) plus bilateral basilar rales (crackles) points strongly to fluid in the alveoli— acute pulmonary edema —often from left-sided heart failure.

Pneumonia can produce crackles but usually lacks that sudden nocturnal orthopnea picture. Emphysema and pulmonary embolism are not the first fit when wet basilar sounds dominate the exam.