Pulmonary edema, ICD code 10. Pulmonary edema - description, diagnosis, treatment

With its help, the unity and comparability of health care materials in all countries is maintained. This classification allows you to keep records of diseases of a global scale, such as tuberculosis or HIV. Pulmonary edema according to ICD 10 is encrypted with certain letters and numbers, like other pathologies.

Encoding features

Acute pulmonary edema is located in class X, which includes all diseases of the respiratory system. direct pathology code is J81. However, some varieties of this complication are present in other classes and sections.

The ICD code 10 for pulmonary edema may be I50.1. This happens when it is caused by cardiac left ventricular failure. The accumulation of fluid is caused by many chronic pathologies of the heart, but most often by myocardial infarction. For its formation, two main criteria are needed: stagnation of blood in the lungs and an increase in capillary resistance.

This edema is also called cardiogenic, cardiac asthma, or left-sided heart failure. . It is important to distinguish cardiogenic swelling from other types according to ICD 10, since it is he who most often ends in the death of the patient.

Much less often, according to ICD 10, pulmonary edema is coded as follows:

J18.2 - occurs due to hypostatic pneumonia;
J168.1 - pulmonary edema of a chemical nature;
J160-170 - the development of swelling is due to exposure to external agents (certain dust, gases, smoke, and so on).

Why code a diagnosis?

Many are perplexed why ICD pulmonary edema should be coded. Moreover, each individual case may have a different designation in the classification. It is rarely needed to treat a pathological process or eliminate its complications. However, the ICD has a large number of important areas of application. With her help:

keep statistics of morbidity and mortality of the population (moreover, both global and individual groups of the population);
conveniently store healthcare data;
assess the situation in the field of epidemiology;
analyzes the relationship of pathology with certain factors;
simplifies global health management.

In addition to the main functions, there are many more highly specialized areas in which the ICD is used. For example, the development of preventive measures, the preparation of treatment protocols, and so on. Therefore, pulmonary edema code allows you to store and use data about this deadly complication worldwide.

The doctor, before putting the appropriate encoding, must take into account all the factors of the pathology that allow it to be attributed to one or another section.

When pathology is detected, it is most important to establish a connection between complications and heart disease. This gives a reason not only to change the pathology code, but also to attribute it to a completely different class of ICD.

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The most typical and severe manifestation of acute heart failure is pulmonary edema. It can develop both against the background of acute violations of the contractility of the left ventricle (myocardial infarction), and as a result of a sharp increase in the load on the heart (severe tachycardia, high blood pressure).

The rapid increase in pressure in the left ventricle that occurs under these conditions leads to an increase in capillary pressure with a sharp increase in the filtration of the liquid part of the plasma through the capillary walls into the interstitial space (interstitial edema). If the amount of filtered fluid exceeds the volume of the interstitium, fluid and red blood cells enter the alveoli (alveolar edema).

Clinical picture

Patients take an elevated position, complain of a pronounced lack of air and palpitations, quickly appear with foamy sputum, anxiety, the skin becomes pale and moist. Characteristic of this condition is a sharp shortness of breath, tachycardia and a decrease in pressure ... Numerous moist rales are heard in the lungs.

emergency therapy

It is necessary to find out the immediate cause of pulmonary edema. It can be acute myocardial ischemia, tachyarrhythmia, hypertensive crisis.
The main directions of therapeutic measures are:
- reducing pressure in the pulmonary circulation (lungs) by reducing preload
- Ensuring sufficient oxygenation of the blood
- decrease in the mass of circulating blood
- the appointment of defoamers to reduce foaming in the lungs

Sublingual intake of 0.4 mg of nitroglycerin or its intravenous administration has a quick effect. This reduces the venous return of blood to the heart and reduces the pressure in the pulmonary veins. Furosemide (Lasix) 40-60 mg can also be injected into a vein. Its vasodilating effect occurs much earlier than the diuretic one. With a low level of systemic arterial pressure, rapid bloodletting is effective - 300-500 ml. 100% humidified oxygen through nasal cannulas will provide the best oxygenation of the blood, and inhalation of 30% ethanol will reduce foaming in the lungs.
Cardiac glycosides can only be used for tachyarrhythmia fibrillation or atrial flutter when a rhythm cannot be established by cardioversion. In other cases, they are not assigned. The use of narcotic analgesics (especially in myocardial infarction) is very useful - morphine 2-6 mg i.v. At the same time, there is a decrease in shortness of breath, tachycardia, excitation, as well as a systemic veno- and arteriolodilating effect. The use of dopamine and dobutamine is possible only with low blood pressure.

The modern world is fraught with many diseases that a person may encounter, their forms, course and distribution are so diverse that, for the effectiveness of medical practice, it was decided to create a unified classification system for diseases that can be used throughout the world. Such a system was the ICD - 10 - the international classification of diseases, which is updated by WHO every ten years.

The classifier allows you to use a unified system for the treatment of certain diseases, as well as analyze the level of death, injury or spread of the disease.

According to the ICD-10, pulmonary edema was assigned the code J81 - pulmonary congestion or acute pulmonary edema, included in respiratory diseases.

ICD encoding and its features

The latest revision of the classifier of diseases included alphabetical grading in the numeric numbering system. This made it possible to expand the classification and deepen it without violating the list of major diseases.

The latest system is considered complete and finalized, it includes:

a complete list of diagnoses, conditions, injuries and other reasons for visiting a doctor - consists of
three-character rubrics and four-character subcategories;
a list of major diseases for keeping statistics of mortality and morbidity of the population;
coding of causes of neoplasms;
factors affecting human health;
list of exceptions;
table of drugs and chemicals.

For example, you can study pulmonary edema, which is numbered J81. It is included in the class "diseases of the respiratory system", in the block "Other respiratory diseases affecting mainly the interstitial tissue". The classification immediately excludes hypostatic pneumonia and offers three more specific cases of the disease:

condition caused after inhalation of chemicals, vapors or gases - chemical edema (J68.1);
caused by external substances - organic and inorganic dust, solid or liquid substances, radiation, toxic substances or drugs (J60-J70);
left-sided heart failure, unless otherwise indicated, can cause pulmonary edema, often leading to myocardial infarction, but pulmonary congestion and capillary resistance lead to alveolar dysfunction (I50.1).

Varieties of pulmonary edema have similar symptoms:

cough;
difficulty breathing;
sitting position with emphasis on hands;
inability to breathe deeply;
pallor and coldness of the skin;
suffocation.

Why code a disease

For the effective operation of the healthcare system, it is necessary to constantly develop and improve the quality of treatment, as well as the development of new areas in the field of medicine and pharmacology. But in order to identify areas of activity, it is necessary that physicians around the world adhere to a single standard treatment system, this will allow evaluating the effectiveness and developing new methods.

To do this, they created a unified international classification system for diseases, which will allow you to receive the following indicators around the world:

incidence statistics around the world, identification of population groups prone to different types of diseases,
and the definition of epidemics;
indicators on the level of mortality, the establishment of causes of death, which allows you to develop
measures to reduce the indicator;
causal relationships of diseases are evaluated;
storage of data on epidemics, levels of morbidity and mortality in recent years;
a standard effective treatment regimen is proposed, taking into account the definition of the morphology of the disease.

All this data allows international healthcare to carry out preventive measures in various population groups, formulate clear requirements for pharmaceutical companies, and introduce new methods of treatment as quickly as possible.

Thanks to this system, anywhere in the world, if a patient develops pulmonary edema, the doctor will apply emergency treatment, which includes a mask with 100% oxygen, possible intubation with positive expiratory pressure, administration of furosemide, morphine and cardiac drugs in case of cardiac factor.

The doctor enters the information received into the patient's card, which also indicates the effectiveness of treatment and possible complications. Data becomes part of the statistical indicators needed for health development.

Pulmonary edema (OL)- life-threatening exudation into the cavity of the alveoli of a protein-rich, easily foaming serous fluid.

Code according to the international classification of diseases ICD-10:

OL cardiac see Cardiac asthma and pulmonary edema. OL is heartless.

The reasons

Etiology and pathogenesis: lung tissue damage - infectious (see Pneumonia), allergic, toxic, traumatic; thromboembolism of a pulmonary artery (see); lung infarction (see); Goodpasture's syndrome (see); 2) violation of water - electrolyte balance, hypervolemia (infusion therapy, renal failure, endocrine pathology and steroid therapy, pregnancy); 3) drowning in salt water; 4) violation of the central regulation - with a stroke, subarachnoid hemorrhage, brain damage (toxic, infectious, traumatic), with overexcitation of the vagal center; 5) decrease in intrathoracic pressure - with rapid evacuation of fluid from the abdominal cavity, fluid or air from the pleural cavity, ascent to a great height, forced inspiration; 6) excessive therapy (infusion, drug, oxygen therapy) for shock, burns, infections, poisoning and other serious conditions, including after major operations ("shock lung"); 7) various combinations of the listed factors, for example, pneumonia in high altitude conditions (immediate evacuation of the patient is necessary!). Filling the alveoli with liquid and foam leads to asphyxia (see): the patient "drowns" in his own serous fluid. Under conditions of hypoxia and acidosis, the permeability of the capillary-alveolar membrane increases, the sweating of serous fluid increases (a vicious circle), the effectiveness of drug therapy decreases (see also Cardiac asthma and pulmonary edema).

Symptoms, course see Cardiac asthma and pulmonary edema, as well as in the listed diseases and conditions, the complication of which was OL.

Treatment

Treatment emergency (danger to life, threat of additional vicious circles), differentiated, determined by specific etiology, pathogenesis and clinical manifestations of AL. In many cases, especially with toxic, allergic and infectious origin of OL with damage to the alveolar-capillary membrane, as well as with arterial hypotension, large doses of glucocorticosteroids are successfully used. Prednisolone hemisuccinate (bisuccinate) repeatedly at 0.025 - 0.15 g - 3 - 6 ampoules (up to 1200 - 1500 mg / day) or hydrocortisone hemisuccinate - 0.125 - 300 mg (up to 1200 - 1500 mg / day) is injected drip into a vein into isotonic sodium chloride solution, glucose or other infusion solution. Nitroglycerin, powerful diuretics, aminofillin are not indicated for hypovolemia, arterial hypotension. Narcotic analgesics are contraindicated in cerebral edema and, as a rule, in primary pulmonary origin of AL. Oxygen therapy may be contraindicated in severe respiratory failure, oligopnea. With a shock lung, infusion therapy, correction of the acid-base state and oxygen therapy should be carried out with great care, under close supervision, as a rule, in a hospital. With these reservations, treatment is carried out in relation to the scheme below in the section Cardiac asthma and pulmonary edema (see).

Diagnosis code according to ICD-10. J81

Pulmonary edema(OL) - accumulation of fluid in the interstitial tissue and / or alveoli of the lungs as a result of plasma extravasation from the vessels of the pulmonary circulation. Pulmonary edema is divided into interstitial and alveolar, which should be considered as two stages of one process. Interstitial pulmonary edema is swelling of the interstitial tissue of the lungs without the release of transudate into the lumen of the alveoli. Clinically manifested by shortness of breath and cough without sputum. As the process progresses, alveolar edema occurs. Alveolar pulmonary edema is characterized by the leakage of blood plasma into the lumen of the alveoli. Patients develop cough with frothy sputum, suffocation, dry rales are heard in the lungs, and then moist rales.

Code according to the international classification of diseases ICD-10:

I50.1

Dominant age- over 40 years old.
Etiology. Cardiogenic OL with low cardiac output.. MI - a large area of damage, rupture of the walls of the heart, acute mitral insufficiency.. Decompensation of chronic heart failure - inadequate treatment, arrhythmias, severe concomitant disease, severe anemia.. Arrhythmias (supraventricular and ventricular tachycardia, bradycardia) .. Obstruction of blood flow - mitral or aortic stenosis, hypertrophic cardiomyopathy, tumors, blood clots.. Valvular insufficiency - mitral or aortic insufficiency.. Myocarditis.. Massive pulmonary embolism.. Cor pulmonale.. Hypertensive crisis.. Cardiac tamponade.. Trauma hearts. Cardiogenic OL with high cardiac output.. Anemia.. Thyrotoxicosis.. Acute glomerulonephritis with arterial hypertension.. Arteriovenous fistula. Non-cardiogenic AR - see Adult Respiratory Distress Syndrome.

Pathomorphology of cardiogenic OL. Intraalveolar transudate is pink. In the alveoli - microhemorrhages and hemosiderin-containing macrophages. Brown induration of the lungs, venous plethora. Hypostatic bronchopneumonia. Autopsy shows heavy, enlarged lungs of dough-like consistency, liquid flows from the cut surface.
clinical picture. Severe shortness of breath (dyspnea) and increased respiration (tachypnea), participation in the act of breathing of auxiliary muscles: inspiratory retraction of the intercostal spaces and supraclavicular fossae. Forced sitting position (orthopnea), anxiety, fear of death. Cyanotic cold skin, profuse sweating. Features of the clinical picture of interstitial AL (cardiac asthma) .. Noisy wheezing, difficulty inhaling (stridor) .. Auscultatory - against the background of weakened breathing, dry, sometimes meager fine bubbling rales. Features of the clinical picture of alveolar OL .. Cough with expectoration of frothy sputum, usually pink in color.. In severe cases, aperiodic Cheyne-Stokes breathing. Changes in the cardiovascular system.. Tachycardia.. Alternating pulse (inconstancy of the amplitude of the pulse wave) in severe left ventricular failure.. Pain in the heart area.. In the presence of heart defects, the presence of appropriate clinical symptoms.

Diagnostics

Laboratory research. Hypoxemia (the degree changes against the background of oxygen therapy). Hypocapnia (comorbid lung disease may complicate interpretation). Respiratory alkalosis. Changes depending on the nature of the pathology that caused AL (increased levels of MB - CPK, troponins T and I in MI, an increase in the concentration of thyroid hormones in thyrotoxicosis, etc.).

Special Studies. ECG - possible signs of left ventricular hypertrophy. Echocardiography is informative for heart defects. Insertion of a Swan-Ganz catheter into the pulmonary artery to determine pulmonary artery wedge pressure (PAWP), which helps in the differential diagnosis between cardiogenic and non-cardiogenic OL. DZLA<15 мм рт.ст. характерно для синдрома респираторного дистресса взрослых, а ДЗЛА >25 mmHg - for heart failure. Chest X-ray.. Cardiogenic OL: expansion of the borders of the heart, redistribution of blood in the lungs, Kerley lines (linear striation due to increased image of the pulmonary interstitium) in interstitial OL or multiple small foci in alveolar OL, often pleural effusion .. Non-cardiogenic OL: the borders of the heart are not expanded, there is no redistribution of blood in the lungs, the effusion into the pleural cavity is less pronounced.

Differential Diagnosis. Pneumonia. Bronchial asthma. TELA. hyperventilation syndrome.

Treatment

TREATMENT. emergency events. Giving the patient a sitting position with legs down (reduction of venous return of blood to the heart, which reduces preload). Adequate oxygenation with a mask with a supply of 100% oxygen at a rate of 6-8 l / min (preferably with defoamers - ethyl alcohol, antifomsilane). With the progression of pulmonary edema (determined by the coverage of all lung fields with moist coarse rales), intubation and mechanical ventilation under positive expiratory pressure are performed to increase intraalveolar pressure and reduce extravasation. The introduction of morphine at a dose of 2-5 mg / in to suppress the excessive activity of the respiratory center. The introduction of furosemide in / in a dose of 40-100 mg to reduce BCC, dilate venous vessels, reduce venous return of blood to the heart. The introduction of cardiotonic drugs (dobutamine, dopamine) to increase blood pressure (see Cardiogenic shock). Reducing afterload with sodium nitroprusside at a dose of 20-30 mcg / min (using a special dispenser) with systolic blood pressure over 100 mm Hg. up to resolution of pulmonary edema. Instead of sodium nitroprusside, intravenous administration of p-ra nitroglycerin is possible. The use of aminophylline at a dose of 240-480 mg IV to reduce bronchoconstriction, increase renal blood flow, increase the release of sodium ions, increase myocardial contractility. Placement of venous tourniquets (tourniquets) on limbs to reduce venous return to the heart. Sphygmomanometer cuffs applied to three limbs can be used as venous tourniquets, with the exception of the one where intravenous drug administration is carried out. The cuff is inflated to values averaging between systolic and diastolic blood pressure, and every 10-20 minutes the pressure in the cuff must be reduced. Inflating the cuffs and reducing the pressure in them must be carried out sequentially on all three limbs. The feasibility of prescribing cardiac glycosides is debated. If pulmonary edema occurs against the background of a hypertensive crisis, it is necessary to administer antihypertensive drugs. Non-cardiogenic edema - see Adult Respiratory Distress Syndrome.

Additionally. Bed rest. Diet with a sharp restriction of salt. Therapeutic bleeding. Blood ultrafiltration (also to reduce BCC). Foam aspiration in alveolar OL.
Complications. Ischemic lesions of internal organs. Pneumosclerosis, especially after non-cardiogenic OL.
Forecast. Depends on the underlying disease that caused OL. Mortality in cardiogenic OL is 15-20%.
Age features. Children: AL is more likely to occur with malformations of the pulmonary system and heart or as a result of injuries. Elderly: OL is one of the most common causes of death.

Pregnancy. Terms of occurrence of OL: 24-36 weeks of pregnancy, during childbirth and in the early postpartum period. The method of delivery depends on the obstetric situation .. In the absence of conditions for delivery through the natural birth canal - caesarean section .. During birth through the birth canal - the imposition of obstetric forceps .. In the absence of conditions for the imposition of forceps - craniotomy. Prevention of AL in pregnant women is important: timely resolution of the issue of the possibility of maintaining pregnancy, stabilization of the pathology of the heart in pregnant women, dynamic monitoring of the state of the cardiovascular system.

Synonyms for cardiogenic OL: . Acute left ventricular failure. cardiac asthma.
Abbreviations. OL - pulmonary edema. PWLA - pulmonary artery wedge pressure

ICD-10. I50.1 Left ventricular failure J81 Pulmonary edema.