Pulmonary edema: types, signs, diagnosis, emergency care and treatment. Pulmonary edema emergency care algorithm Pulmonary edema pathogenesis clinic treatment
Pulmonary edema- a syndrome that occurs suddenly, is characterized by the accumulation of fluid in the lungs (in the interstitium, pulmonary alveoli), followed by a violation of gas exchange in the lungs and the development of hypoxia (lack of oxygen in the blood), manifested by cyanosis (cyanosis) of the skin, severe suffocation (lack of air).
The lungs are a paired organ that is involved in the exchange of gases between the blood and the pulmonary alveoli. The walls of the pulmonary alveoli (thin-walled sac) and the walls of the capillaries (surrounding the alveoli) participate in gas exchange. Pulmonary edema develops as a result of the transfer of fluid from the pulmonary capillaries (due to increased pressure or low levels of blood protein) into the alveoli of the lungs. Lungs filled with water lose their functional capacity.
Pulmonary edema, depending on the causes, is of two types:
- hydrostatic edema- develops as a result of diseases that lead to an increase in intravascular hydrostatic pressure and the release of the liquid part of the blood from the vessel into the interstitial space, and subsequently into the alveolus;
- membranous edema- develops as a result of the action of toxins (endogenous or exogenous), which violate the integrity of the alveolar wall and / or capillary wall, followed by the release of fluid into the extravascular space.
Anatomy and physiology of the lung
The lung is a paired organ of the respiratory system, located in the cavity of the chest. The left and right lungs are located in separate pleural sacs (shells), separated by the mediastinum. They differ slightly from each other in size and some anatomical structures. The lung resembles the shape of a truncated cone, with its apex up (toward the clavicle), and its base down. Lung tissue, which has high elasticity and extensibility, is an important point in the performance of the respiratory function. Through each lung from the inside, a bronchus, vein, artery and lymphatic vessels pass.In order to understand exactly where the accumulation of fluid occurs during pulmonary edema, it is necessary to know their internal structure. The formation of the skeleton of the lungs begins with the main bronchi, which flow into each lung, which in turn are divided into 3 lobar bronchi, for the right lung, and 2 for the left lung. Each of the lobar bronchi divides into segmental bronchi, which end in bronchioles. All of the above formations (from the main bronchi to the bronchioles) form the bronchial tree, which performs the function of conducting air. The bronchioles flow into the secondary pulmonary lobules, and there they divide into bronchioles of 2-3 orders. Each secondary pulmonary lobule contains about 20 bronchioles of 2-3 orders, and they, in turn, are divided into respiratory bronchioles, which, after division, flow into the respiratory passages ending in alveoli (sacs). There are about 350 million alveoli in each lung. All alveoli are surrounded by capillaries, both of these structures are actively involved in gas exchange, with any pathology of one of the structures, the process of gas exchange (oxygen and carbon dioxide) is disturbed.
- The mechanism of external respiration and gas exchange in the lungs
- Circulation of the lung
Mechanisms of development of pulmonary edema
Pulmonary edema develops through 3 main mechanisms:- Increased hydrostatic pressure (increased blood volume). As a result of an acute increase in pressure in the capillaries involved in the formation of the pulmonary circulation, the permeability of the capillary wall is disturbed, followed by the release of the liquid part of the blood into the interstitial tissue of the lung, which the lymphatic system is unable to cope with (drain), as a result of which the alveoli are saturated with fluid . Alveoli filled with water, unable to participate in gas exchange, this leads to an acute lack of oxygen in the blood (hypoxia), followed by blue tissue (accumulation of carbon dioxide) and symptoms of severe suffocation.
- Decreased oncotic (low protein) blood pressure. There is a difference between the oncotic pressure of the blood and the oncotic pressure of the intercellular fluid, and in order to compare this difference, the fluid from the vessel enters the extracellular space (interstitium). Thus, pulmonary edema with its clinical manifestations develops.
- Direct damage to the alveolocapillary membrane. As a result of exposure to various causes, the protein structure of the alveolocapillary membrane is damaged, the release of fluid into the interstitial space, followed by the above consequences.
Causes of pulmonary edema
- Decompensated heart disease, accompanied by insufficiency of the left heart and stagnation in the pulmonary circulation (mitral valve defects, myocardial infarction). With severe defects and not provided during medical care, the pressure in the pulmonary circulation (in the capillaries) increases, with the possible development of pulmonary edema, according to the mechanism of increased hydrostatic blood pressure. Also, the cause of stagnation in the pulmonary circulation are: pulmonary emphysema, bronchial asthma;
- Thromboembolism of the pulmonary artery or its branches. In patients who are predisposed to the formation of blood clots (hypertension, varicose veins of the lower extremities or others), under certain unfavorable conditions, a blood clot occurs, or an already existing blood clot is torn off. Through the blood flow, a thrombus can reach the pulmonary artery or its branches, and if the diameter of the thrombus and the diameter of the vessel coincide, a blockage occurs, which leads to an increase in pressure in the pulmonary artery of ˃25 mm/Hg, and, accordingly, the pressure in the capillaries also increases. All of the above mechanisms lead to an increase in hydrostatic pressure in the capillaries and the development of pulmonary edema;
- Toxins (endogenous or exogenous) and diseases accompanied by the release of toxins that can disrupt the integrity of the alveolocapillary membrane. These include: an overdose of certain drugs (Apressin, Mielosan, Fentanyl and others), the toxic effect of bacterial endotoxins in sepsis (infection in the bloodstream), acute lung diseases (pneumonia), inhalation and overdose of cocaine, heroin, radiation damage to the lungs and others. . Damage to the alveolocapillary membrane leads to an increase in its permeability, the release of fluid into the extravascular space and the development of pulmonary edema;
- Diseases accompanied by a decrease in the level of protein in the blood (low oncotic pressure): liver disease (cirrhosis), kidney disease with nephrotic syndrome, and others. All of the above diseases are accompanied by a decrease in oncotic blood pressure, contribute to the possible development of pulmonary edema according to the above mechanism;
- Chest trauma, prolonged compression syndrome (Crash syndrome), pleurisy (inflammation of the pleura), pneumothorax (air in the pleural cavity);
- Uncontrolled, intravenous infusion of solutions, without forced diuresis (Furosemide), leads to an increase in hydrostatic blood pressure with the possible development of pulmonary edema.
Symptoms of pulmonary edema
Symptoms of pulmonary edema appear suddenly, most often at night (associated with the patient's lying position) and begin with the following manifestations:- Attacks of severe, painful suffocation (lack of air), aggravated in the lying position, so the patient must take a forced position (sitting or lying down), develop as a result of a lack of oxygen;
- Severe dyspnea develops in a patient at rest (i.e., not associated with physical activity);
- Pressive pain in chest due to lack of oxygen;
- A sharp increase in breathing (superficial, bubbling, heard at a distance) is associated with stimulation of the respiratory center by carbon dioxide that has not been released;
- Rapid heartbeat due to lack of oxygen;
- First, coughing, and then coughing with pronounced wheezing and frothy sputum, pink;
- The skin of the patient's face, gray - bluish in color, with a subsequent increase in other parts of the body, is associated with the accumulation and violation of the release of carbon dioxide from the blood;
- Cold sticky sweat and pallor of the skin develop as a result of centralization of blood (on the periphery to the center);
- The veins in the neck swell, which occurs as a result of stagnation in the pulmonary circulation;
- It is possible to develop an increase in blood pressure;
- The consciousness of the patient is confused, if not provided during medical care, up to the absence of consciousness;
- Pulse weak, thready.
Diagnosis of the causes of pulmonary edema
It is very important, before carrying out all the necessary research methods, to carefully collect an anamnesis, in which you can find out the possible cause of the development of pulmonary edema (for example: heart failure, renal failure, or others).If the patient is confused and unable to talk to him, then it is necessary to carefully evaluate all clinical manifestations in order to determine the possible cause of the development of pulmonary edema in order to eliminate its consequences. The plan of laboratory and instrumental methods of examination for each patient is selected individually, depending on the clinical manifestations and the possible cause that caused pulmonary edema.
- Percussion of the chest: dullness of the chest above the lungs. This method is not specific, it confirms that there is a pathological process in the lungs that contributes to the compaction of the lung tissue;
- Auscultation of the lungs: hard breathing is heard, the presence of wet, coarse rales in the basal parts of the lungs;
- Pulse measurement: with pulmonary edema, the pulse is frequent, thready, of weak filling;
- Measurement of blood pressure: most often the pressure rises, above 140 mm / hg;
Laboratory diagnostic methods
- determining the concentration of gases in arterial blood: partial pressure of carbon dioxide 35mm/Hg; and partial pressure of oxygen 60 mm/Hg;
- Biochemical blood test: used to differentiate the causes of pulmonary edema (myocardial infarction or hypoproteinemia). If pulmonary edema is caused by myocardial infarction, then the level of troponins in the blood is 1 ng / ml and the CF fraction of creatine phosphokinase is 10% of its total amount.
- Coagulogram a (blood clotting ability) changes with pulmonary edema caused by pulmonary embolism. Increase in fibrinogen 4 g/l, increase in prothrombin 140%.
Instrumental diagnostic methods
- Pulse oximetry (determines the concentration of oxygen binding to hemoglobin), reveals a low oxygen concentration, below 90%;
- Measurement of central venous pressure (blood flow pressure in large vessels) using a Waldmann phlebotonometer connected to a punctured subclavian vein. With pulmonary edema, central venous pressure rises to 12 mm/Hg;
- Chest X-ray reveals signs confirming the presence of fluid in the lung parenchyma. A homogeneous darkening of the lung fields is revealed in their central sections, on both sides or on one side, depending on the cause. If the cause is associated, for example, with heart failure, then the edema will be noted on both sides, if the cause is, for example, unilateral pneumonia, then the edema will accordingly be one-sided;
- Electrocardiography (ECG) allows you to determine changes in the heart, if pulmonary edema is associated with cardiac pathology. On the ECG can be recorded: signs of myocardial infarction or ischemia, arrhythmias, signs of hypertrophy of the walls, left heart;
- Echocardiography (Echo KG, ultrasound of the heart) is used if the above changes are detected on the ECG to determine the exact cardiac pathology that caused pulmonary edema. Echo KG may show the following changes: reduced ejection fraction of the heart, thickening of the walls of the chambers of the heart, the presence of valvular pathology, and others;
- Pulmonary artery catheterization is a complex procedure and is not required for all patients. It is often used in cardioanesthesiology, performed in the operating room, in patients with cardiac pathology, which is complicated by pulmonary edema, if there is no reliable evidence of the effect of cardiac output on pulmonary artery pressure.
Treatment of pulmonary edema
Pulmonary edema is an emergency condition, therefore, at the first symptoms of it, it is necessary to call an ambulance. Treatment is carried out in the intensive care unit, under the constant supervision of the doctor on duty.A patient with pulmonary edema needs emergency medical care, which is performed during transportation to the hospital:
- Give the patient a semi-sitting position;
- Oxygen therapy: applying an oxygen mask or, if necessary, intubation of the lungs with artificial ventilation of the lungs;
- Apply venous tourniquets to the upper third of the thighs, but so that the pulse does not disappear (for no more than 20 minutes), the tourniquets are removed with gradual relaxation. This is done in order to reduce the flow to the right side of the heart in order to prevent a further increase in pressure in the pulmonary circulation;
- Nitroglycerin tablet under the tongue;
- For pain relief, intravenous administration of narcotic analgesics (Morphine 1% 1 ml);
- Diuretics: Lasix 100 mg IV.
Treatment in the emergency department, treatment is carried out under strict constant monitoring of hemodynamics (pulse, pressure) and respiration. The attending physician prescribes treatment individually, depending on the clinic and the cause that caused pulmonary edema. The introduction of almost all drugs is carried out through a catheterized subclavian vein.
Groups of drugs used for pulmonary edema:
- Inhalation of oxygen in combination with ethyl alcohol is used to extinguish the foam that forms in the lungs;
- Intravenous, drip administration of Nitroglycerin, 1 ampoule diluted with saline, the number of drops per minute, depending on the level of blood pressure. It is used in patients with pulmonary edema, accompanied by high blood pressure;
- Narcotic analgesics: Morphine - 10 mg IV, fractionally;
- With pulmonary edema, accompanied by a decrease in blood pressure, Dobutamine or Dopamine preparations are administered to increase the strength of heart contraction;
- In case of pulmonary edema caused by pulmonary embolism, Heparin 5000 U is administered intravenously, then 2000-5000 U per hour, diluted in 10 ml of saline, for anticoagulant action;
- Diuretic drugs: Furosemide at first 40 mg, if necessary, repeat the dose, depending on diuresis and blood pressure;
- If pulmonary edema is accompanied by a low heartbeat, Atropine is administered intravenously up to 1 mg, Eufillin 2.4% - 10 ml;
- Glucocorticoids: Prednisolone 60-90 mg IV bolus, with bronchospasm;
- In case of insufficiency of protein in the blood, patients are prescribed an infusion of fresh frozen plasma;
- In infectious processes (sepsis, pneumonia, or others), broad-spectrum antibiotics (Ciprofloxacin, Imipenem) are prescribed.
Prevention of pulmonary edema
Prevention of pulmonary edema consists in the early detection of diseases leading to pulmonary edema, and their effective treatment. Compensation for cardiac pathologies (ischemic heart disease, hypertension, acute cardiac arrhythmias, heart defects) helps to prevent the development of pulmonary edema, cardiac genesis, which takes the first place.Also, patients suffering from chronic heart failure should follow a diet that includes: limiting the daily intake of salt and fluid intake, excluding fatty foods, excluding physical activity, as it increases shortness of breath. Chronic pulmonary pathologies (emphysema, bronchial asthma) are in second place for the causes of pulmonary edema. To compensate for them, the patient must adhere to the following recommendations: be under constant supervision of the attending physician, supportive therapy on an outpatient basis, 2 times a year to treat in a hospital, prevent possible factors that worsen the patient's condition (acute respiratory diseases, contact with various allergens, smoking cessation, etc.). Prevention or premature and effective treatment of acute pulmonary diseases (pneumonia of various origins) and other conditions leading to pulmonary edema.
What are the consequences of pulmonary edema?
The consequences of pulmonary edema can be extremely varied. As a rule, with pulmonary edema, favorable conditions are created for damage to internal organs. This is due to the fact that due to ischemia there is a significant decrease in the flow of arterial blood to organs and tissues. Ischemia, in turn, occurs when there is insufficient pumping function of the left ventricle ( cardiogenic pulmonary edema). The most pronounced pathological changes are observed in tissues that need oxygen in large quantities - the brain, heart, lungs, adrenal glands, kidneys and liver. Abnormalities in these organs can exacerbate acute heart failure ( decrease in the contractile function of the heart muscle), which can be fatal. In addition, after pulmonary edema, some diseases of the respiratory system often occur.
Pulmonary edema can lead to the following diseases:
- lung atelectasis;
- congestive pneumonia;
pneumosclerosis is the replacement of functional lung tissue with connective tissue ( scar tissue). Pneumosclerosis occurs as a result of inflammatory-dystrophic processes caused by pulmonary edema. For pneumosclerosis is characterized by a decrease in the elasticity of the walls of the affected alveoli. Also, to a certain extent, the process of gas exchange is disturbed. In the future, against the background of the growth of connective tissue, bronchi of different calibers can be deformed. If pneumosclerosis is limited ( occurs in a small area of lung tissue), then, as a rule, the gas exchange function does not change much. If pneumosclerosis is diffuse, with damage to most of the lung tissue, then there is a significant decrease in lung elasticity, which affects the process of gas exchange.
congestive pneumonia is a secondary inflammation of the lung tissue, which occurs against the background of hemodynamic disorders ( circulatory disorder) in the pulmonary circulation ( ). Congestive pneumonia is a consequence of overflow of blood in the pulmonary veins, which occurs due to a violation of the outflow of blood in case of insufficiency of the function of the left ventricle of the heart. This pathology is manifested by cough, shortness of breath, separation of mucous and / or purulent sputum, fever up to 37 - 37.5ºС, weakness, and in some cases hemoptysis ( hemoptysis).
Emphysema is a pathological expansion of the terminal ( distal) bronchioles along with damage to the walls of the alveoli. With this pathology, the chest becomes barrel-shaped, the supraclavicular regions swell. On percussion of the chest percussion) reveals a clear box sound. Also, emphysema is characterized by moderate or severe shortness of breath. It is with her that the disease usually begins. With this pathology, the gas composition of the blood is often disturbed ( the ratio of carbon dioxide to oxygen in the blood).
It should be noted that there is also a possibility of recurrence ( re-occurrence) pulmonary edema. If the cause that led to pulmonary edema is not treated in a timely manner ( heart failure, heart disease, etc.), then the likelihood of recurrent pulmonary edema is high.
What is the treatment time for pulmonary edema?
The duration of treatment for pulmonary edema depends on the type of edema ( cardiogenic or non-cardiogenic), comorbidities, general health and age of the patient. As a rule, the terms of treatment can vary from 1 to 4 weeks. If pulmonary edema proceeds without complications ( in the absence of pneumonia, infection or lung atelectasis), as well as when providing adequate and timely therapy, the terms of treatment in most cases do not exceed 5-10 days.
It is worth noting that the most severe form of pulmonary edema is toxic pulmonary edema, which occurs when poisoned with medicines, poisons or poisonous gases. It is characterized by the frequent development of complications, such as pneumonia, emphysema ( ) or pneumosclerosis ( replacement of lung tissue with connective tissue). In rare cases, an exacerbation of tuberculosis may occur, which previously proceeded in a latent ( hidden) form or other chronic infectious diseases. In addition to the above complications, toxic pulmonary edema may relapse ( re-occurrence) of this pathology against the background of acute heart failure ( most often occurs at the end of the second or beginning of the third week). That is why patients with toxic pulmonary edema should be under medical supervision for at least 3 weeks.
What are the forms and periods of toxic pulmonary edema?
There are two main forms of toxic pulmonary edema - developed and abortive. Developed ( completed) the form of toxic pulmonary edema has 5 periods, and the abortive form has 4 ( there is no stage of completed pulmonary edema). Each period is characterized by certain manifestations and duration. The following periods of pulmonary edema are distinguished:
- stage of reflex disorders;
- a latent period of remission of reflex disturbances;
- period of increasing pulmonary edema;
- the period of completed pulmonary edema;
- the period of reverse development of edema.
The latent period of remission of reflex disorders characterized by the subsidence of the above manifestations and temporary well-being. This phase can last from 6 to 24 hours. With a thorough medical examination, bradycardia can be detected already in this period ( decrease in the number of heartbeats), as well as pulmonary emphysema ( increased airiness of lung tissue). These manifestations indicate impending pulmonary edema.
The period of increasing pulmonary edema lasts approximately 22 - 24 hours. This phase is slow. Manifestations occur within the first 5 - 6 hours and further increase. This period is characterized by an increase in body temperature up to 37ºС, a large number of neutrophils are found in the blood ( subspecies of white blood cells). There is also a painful and paroxysmal cough.
The period of completed pulmonary edema characterized by the appearance of pronounced violations. The skin and mucous membranes become bluish in color due to the high content of carbon dioxide in the superficial blood vessels ( cyanosis). In the future, noisy, bubbling breathing appears with a frequency of up to 50 - 60 times per minute. Also, frothy sputum often appears along with blood. If these manifestations are accompanied by collapse ( pronounced drop in blood pressure), then the upper and lower limbs become cold, the number of heartbeats increases significantly, the pulse becomes superficial and thready. Often there is blood clotting ( hemoconcentration). It should be noted that improper transportation in this period can worsen the patient's condition ( the patient should be transported in a semi-sitting position).
The period of regression of pulmonary edema occurs when prompt and qualified medical care is provided. Gradually, coughing, shortness of breath decrease, the skin regains its normal color, and wheezing and foamy sputum also disappear. X-ray first disappear large, and then small lesions of the lung tissue. The composition of peripheral blood is also normalized. The duration of recovery can vary greatly depending on the presence of concomitant diseases, as well as complications that can often occur with toxic pulmonary edema.
It should also be noted that there is a so-called "silent" toxic pulmonary edema. This rare form can be detected only with an X-ray examination of the respiratory organs, since clinical manifestations, as a rule, are not very pronounced or are completely absent.
What can lead to allergic pulmonary edema and how does it manifest itself?
Pulmonary edema can develop not only as a result of pathology of the cardiovascular system, liver, poisoning with poisons or chest injuries, but also against the background of various allergic reactions. Allergic pulmonary edema can occur when various allergens enter the body. Most often, pulmonary edema occurs with the bites of wasps and bees due to increased individual sensitivity to the poisons of these insects. Also, in some cases, this pathology can be caused by taking medications or can occur during the transfusion of blood products.
Allergic pulmonary edema is characterized by the development of clinical manifestations within the first seconds or minutes after the allergen enters the human body. At the initial stage, there is a burning sensation in the tongue. The skin of the head, face, upper and lower extremities begins to itch strongly. In the future, these symptoms are accompanied by discomfort in the chest, pain in the region of the heart, shortness of breath, as well as heavy breathing. The rales, which were first heard in the lower lobes of the lungs, spread to the entire surface of the lungs. The skin and mucous membranes become bluish due to the accumulation of carbon dioxide ( cyanosis). In addition to these symptoms, other manifestations are also possible, such as nausea, vomiting, and abdominal pain. Rarely, urinary incontinence or fecal incontinence has been observed. In case of prolonged hypoxia ( oxygen starvation) of the brain caused by insufficiency of the left ventricle of the heart, convulsions similar to epileptic ones may occur.
In case of allergic pulmonary edema, it is necessary to quickly remove the insect sting ( the sting should be removed with a sliding movement of a knife or nail, and a tourniquet should be applied above the bite site for 2 minutes at intervals of 10 minutes); stop blood transfusion blood transfusion) or taking medicines that caused an allergic reaction. The patient should be seated in a semi-sitting position and an ambulance should be called immediately.
What are the complications of pulmonary edema?
Pulmonary edema is a serious condition that requires urgent therapeutic measures. In some cases, pulmonary edema can be accompanied by extremely dangerous complications. Pulmonary edema can lead to the following complications:
- lightning-fast form of pulmonary edema;
- respiratory depression;
- asystole;
- blockage of the airways;
- unstable hemodynamics;
- cardiogenic shock.
Respiratory depression usually occurs with toxic pulmonary edema ( in case of poisoning with toxic poisons, gases or drugs). Most often, this can occur after taking large doses of narcotic painkillers ( morphine), barbiturates ( phenobarbital) and some other medicines. This complication is associated with a direct inhibitory effect of the drug on the respiratory center located in the medulla oblongata.
Asystole represents a complete cessation of cardiac activity. In this case, asystole occurs due to a severe disease of the cardiovascular system ( myocardial infarction, pulmonary embolism, etc.), which can lead to both pulmonary edema and asystole.
Airway blockage occurs due to the formation of a large amount of foam. Foam is formed from fluid that accumulates in the alveoli. From about 100 milliliters of transudate ( liquid part of blood) 1 - 1.5 liters of foam is formed, which significantly disrupts the gas exchange process due to obstruction ( blockages) respiratory tract.
Unstable hemodynamics manifested by high or low blood pressure. In some cases, pressure drops can alternate, which extremely adversely affects the walls of blood vessels. Also, these changes in blood pressure greatly complicate the implementation of therapeutic measures.
Cardiogenic shock is severe left ventricular failure. With cardiogenic shock, there is a significant decrease in the blood supply to tissues and organs, which can endanger the life of the patient. With this complication, blood pressure falls below 90 mm Hg. Art., the skin becomes cyanotic ( due to the accumulation of carbon dioxide), as well as a decrease in daily diuresis ( diuresis). Due to a decrease in the flow of arterial blood to the brain cells, confusion can be observed, up to stupor ( deep depression of consciousness). It should be noted that cardiogenic shock in most cases leads to death ( in 80 - 90% of cases), as it disrupts the functioning of the central nervous system, cardiovascular and other systems in a short time.
Is there recurrent pulmonary edema?
If the cause that led to pulmonary edema is not eliminated in time, then a relapse is possible ( recurrence of the disease) of this pathology. The most common recurrence of pulmonary edema may occur due to left ventricular failure. Pronounced congestion in the pulmonary veins leads to an increase in intravascular pressure in the capillaries ( ) of the lungs, which leads to the release of the liquid part of the blood into the intercellular space of the lung tissue. In the future, with an increase in pressure, the integrity of the alveoli is violated and penetration into them and into the respiratory tract ( bronchioles) fluids ( actual pulmonary edema). If adequate therapy based on compensation of left ventricular failure is not carried out in a timely manner, then there is a real threat of recurrence of cardiogenic ( caused by pathology of the cardiovascular system) pulmonary edema.
There is also a possibility of secondary pulmonary edema in individuals with chronic heart failure. In this case, recurrent pulmonary edema most often occurs within the first two or three weeks after the first. In persons with chronic heart failure, in addition to basic therapeutic measures ( normalization of hydrostatic pressure in the vessels of the lungs, a decrease in foaming in the lungs and an increase in oxygen saturation in the blood) it is equally important to continuously monitor the pumping function of the left ventricle of the heart for at least several weeks.
To prevent recurrent pulmonary edema, it is recommended to adhere to the following rules:
- Complete and adequate therapy. It is necessary not only to provide timely and complete medical care at the pre-hospital and hospital stages, but also to carry out a set of measures aimed at compensating for the pathological condition that led to the onset of pulmonary edema. With cardiogenic pulmonary edema, coronary heart disease, arrhythmia, hypertension are treated ( increased blood pressure), cardiomyopathy ( structural and functional changes in the heart muscle) or various heart defects ( mitral valve insufficiency, aortic valve stenosis). Treatment of non-cardiogenic edema is based on the detection and adequate treatment of a disease not associated with the pathology of the cardiovascular system. Such a cause can be cirrhosis of the liver, acute poisoning with toxic substances or medicines, an allergic reaction, chest trauma, etc.
- Limitation of physical activity. Increased physical activity creates favorable conditions for the onset and intensification of shortness of breath. That is why people who have predisposing diseases to the occurrence of pulmonary edema ( diseases of the cardiovascular system, liver or kidneys), should give up moderate and increased physical activity.
- Dieting. Proper and balanced nutrition with the exception of a large amount of salt, fat and fluid intake is a necessary preventive measure. Compliance with the diet reduces the load on the cardiovascular system, kidneys and liver.
- Periodic medical supervision. It is equally important, with existing pathologies of the cardiovascular system, respiratory system, liver or kidneys, to be observed by a doctor several times a year. It is the doctor who can identify in the early stages progressive conditions that can lead to pulmonary edema and prescribe the necessary treatment in a timely manner.
What is the prognosis for pulmonary edema?
The prognosis depends on the type of pulmonary edema ( the reason that caused it), severity, concomitant diseases, as well as how well and quickly medical care was provided. The most unfavorable prognosis is observed with toxic pulmonary edema, which can be caused by an overdose of certain drugs, inhalation of poisons or toxic fumes. It is with this form of pulmonary edema that the highest mortality is observed. This is due to the fact that quite often toxic pulmonary edema can lead to serious complications ( congestive pneumonia, lung atelectasis, sepsis), and also manifest itself as a lightning-fast form, in which the patient dies within a few minutes. Also, toxic pulmonary edema is characterized by the occurrence of sudden cardiac or respiratory arrest.
The following pathological conditions worsen the prognosis of pulmonary edema:
- myocardial infarction;
- cardiogenic shock;
- dissecting aortic aneurysm;
- asystole;
- sepsis;
- cirrhosis of the liver;
- unstable hemodynamics.
Cardiogenic shock is an acute insufficiency of the left ventricle of the heart, which is manifested by a pronounced decrease in the pumping function of the heart muscle. This pathological condition is characterized by a sharp decrease in blood pressure ( below 90 mm Hg. Art.). Excessively low blood pressure leads to a decrease in blood supply to tissues ( hypoperfusion) such vital organs as the heart, lungs, liver, kidneys, brain. Also, in addition to the collapse ( excessive pressure drop) there is cyanosis of the skin and mucous membranes ( skin turns blue) due to the accumulation of large amounts of carbon dioxide in the surface vessels. It should be noted that cardiogenic shock, as a rule, occurs as a result of myocardial infarction and significantly worsens the prognosis, since it leads to death in approximately 80–90% of cases.
Dissecting aortic aneurysm is also an extremely severe pathology, which very often leads to death. With this pathology, stratification occurs, and later the rupture of the largest artery in the human body - the aorta. Rupture of the aorta leads to massive blood loss, from which death occurs within minutes or hours ( loss of more than 0.5 liters of blood in a short time leads to death). As a rule, dissecting aortic aneurysm leads to death in more than 90% of cases, even with timely and adequate treatment.
Asystole characterized by complete cessation of cardiac activity heart failure). Asystole is most often the result of myocardial infarction, pulmonary embolism ( blockage of a pulmonary artery) or may occur with an overdose of certain drugs. Only timely medical care during the first 5-6 minutes after asystole can save the patient's life.
Sepsis(blood poisoning) is a serious condition in which pathogens circulate throughout the body along with the toxins they produce. With sepsis, the overall resistance of the body drops sharply. Sepsis leads to an increase in body temperature above 39°C or below 35°C. There is also an increase in heart rate over 90 beats per minute) and breath ( over 20 breaths per minute). An increased or decreased number of white blood cells is found in the blood ( more than 12 or less than 4 million cells). Pulmonary edema aggravated by severe sepsis also has an extremely poor prognosis.
Cirrhosis of the liver characterized by the replacement of functional liver tissue with connective tissue. Cirrhosis of the liver leads to a decrease in protein synthesis by the liver, due to which oncotic pressure decreases ( blood protein pressure). In the future, the balance between the oncotic pressure of the intercellular fluid in the lungs and the oncotic pressure of the blood plasma is disturbed. In order to restore this balance again, part of the fluid from the bloodstream enters the intercellular space of the lungs, and then into the alveoli themselves, which causes pulmonary edema. Cirrhosis of the liver directly leads to liver failure, and in the future, against the background of this pathological condition, pulmonary edema may occur again.
Unstable hemodynamics manifested by sudden changes in blood pressure below 90 and above 140 mm Hg. Art.). These pressure drops significantly complicate the treatment of pulmonary edema, since completely different therapeutic measures are carried out at different values of blood pressure.
Is pulmonary edema treated with folk remedies?
Pulmonary edema is an emergency condition that, if not treated promptly, can lead to serious consequences and sometimes death. That is why the treatment of pulmonary edema should be carried out by experienced doctors in the intensive care unit of the hospital. However, traditional medicine can be resorted to when the patient's condition is successfully stabilized and the possibility of undesirable consequences remains extremely low. These folk remedies will help reduce the severity of some residual symptoms ( cough, sputum), and can also be used as a prophylaxis for pulmonary edema. During the recovery period(completion of illness)You can use the following folk remedies:
- A decoction of flax seeds. It is necessary to pour 4 teaspoons of flax seeds with one liter of water, and then boil for 5 to 7 minutes. Then the pan with the contents is removed from the heat and insisted in a warm place for 4-5 hours. Take this decoction for half a cup, 5-6 times a day ( after 2 - 2.5 hours).
- Tincture of lovage roots. It is necessary to take 40 - 50 grams of dried lovage roots, boil them in 1 liter of water for 10 minutes. Then the tincture should be left in a warm place for 30 minutes. You can take the tincture regardless of the meal 4 times a day.
- A decoction of parsley seeds. The seeds need to be crushed well, and then take 4 teaspoons and pour them with 1 cup of boiling water and boil for 20 minutes. Next, you should cool the broth and strain. This decoction should be taken one tablespoon 4 times a day after meals.
- A decoction of cyanosis roots. A tablespoon of well-chopped cyanosis roots is poured into 1 liter of water, and then kept in a water bath for 30 minutes. The decoction should be taken 50 - 70 milliliters 3 - 4 times a day after meals.
It is worth noting that the treatment of folk remedies is not an alternative to the medical treatment of pulmonary edema. No medicinal decoctions and tinctures can replace modern medicines, as well as medical care provided by conscientious doctors. Also, some medicinal plants, interacting with prescribed medications, can lead to adverse reactions. That is why you should consult with your doctor when deciding to be treated with traditional medicine.
What are the types of pulmonary edema?
In total, there are two types of pulmonary edema - cardiogenic and non-cardiogenic. The first type occurs against the background of some serious diseases of the cardiovascular system. In turn, non-cardiogenic pulmonary edema can occur due to pathologies that are absolutely not related to heart disease ( hence the name).Types of pulmonary edema
| Criteria | Cardiogenic pulmonary edema | Non-cardiogenic pulmonary edema |
| Pathological conditions that can lead to pulmonary edema |
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It should be noted that, unlike cardiogenic pulmonary edema, non-cardiogenic edema occurs somewhat less frequently. The most common cause of pulmonary edema is myocardial infarction.
There are the following subspecies of non-cardiogenic pulmonary edema:
- toxic pulmonary edema;
- allergic pulmonary edema;
- neurogenic pulmonary edema;
- cancerous pulmonary edema;
- traumatic pulmonary edema;
- shock pulmonary edema;
- aspiration pulmonary edema;
- high-altitude pulmonary edema.
Allergic pulmonary edema occurs in individuals with high individual sensitivity to certain allergens. Most often, allergic pulmonary edema is caused by the bite of insects such as wasps or bees. In rare cases, this pathology can occur with massive blood transfusions ( an allergic reaction to foreign proteins in the blood). If the effect of the allergen on the body is not eliminated in time, then there is a high probability of developing anaphylactic shock ( immediate allergic reaction) and death.
Neurogenic pulmonary edema is a fairly rare type of non-cardiogenic pulmonary edema. With this pathology, due to a violation of the innervation of the vessels of the respiratory system, a significant spasm of the veins occurs. In the future, this leads to an increase in the hydrostatic pressure of the blood inside the capillaries ( the smallest vessels that participate together with the alveoli in the process of gas exchange). As a result, the liquid part of the blood leaves the bloodstream into the intercellular space of the lungs, and then enters the alveoli themselves ( pulmonary edema occurs).
Cancer pulmonary edema occurs against the background of a malignant lung tumor. Normally, the lymphatic system should be able to drain excess fluid from the lungs. In lung cancer, the lymph nodes are unable to function normally ( obstruction of the lymph nodes), which can further lead to the accumulation of transudate ( edematous fluid) in the alveoli.
Traumatic pulmonary edema may occur when the integrity of the pleura is violated ( thin membrane that covers each lung). Most often, such pulmonary edema occurs with pneumothorax ( accumulation of air in the pleural cavity). Pneumothorax often damages the capillaries ( tiny vessels), which are located near the alveoli. In the future, the liquid part of the blood and some of the formed elements of the blood ( red blood cells) enter the alveoli and cause pulmonary edema.
Shock pulmonary edema is the result of a state of shock. In shock, the pumping function of the left ventricle drops sharply, which causes stagnation in the pulmonary circulation ( blood vessels connecting the heart and lungs). This inevitably leads to an increase in intravascular hydrostatic pressure and the release of part of the fluid from the vessels into the lung tissue.
Aspiration pulmonary edema occurs when stomach contents enter the airways bronchi). Airway obstruction inevitably leads to membranogenic pulmonary edema ( negative effect on the capillary membrane), in which there is an increase in the permeability of capillaries and the release of the liquid part of the blood from them into the alveoli.
high-altitude pulmonary edema one of the rarest types of pulmonary edema. This pathological condition occurs when climbing a mountain above 3.5 - 4 kilometers. With high-altitude pulmonary edema, the pressure in the vessels of the lungs rises sharply. Capillary permeability also increases due to increasing oxygen starvation, which leads to pulmonary edema ( alveoli are very sensitive to oxygen starvation).
What are the features of pulmonary edema in children?
Pulmonary edema in children, unlike adults, rarely occurs against the background of any pathology of the cardiovascular system. Most often this occurs against the background of an allergic reaction ( allergic pulmonary edema) or by inhalation of toxic substances ( toxic pulmonary edema). At the same time, pulmonary edema can occur against the background of existing heart defects ( acquired heart defects), such as mitral valve regurgitation ( mitral valve dysfunction in which blood from the left ventricle is thrown into the left atrium) and aortic valve stenosis ( narrowing of the opening through which blood from the left ventricle enters the aorta).Pulmonary edema in children can occur at any time of the day, but more often it occurs at night. The child becomes restless and frightened due to the severe lack of air that occurs with pulmonary edema. Sometimes the child may take a forced position in which he sits on the edge of the bed with his legs down ( in this position, the pressure in the vessels of the pulmonary circulation decreases slightly, which leads to a decrease in shortness of breath). In addition, there are a number of manifestations of pulmonary edema in children.
The following symptoms of pulmonary edema in children are distinguished:
- dyspnea;
- cough;
- secretion of pink and foamy sputum;
- wheezing;
- cyanosis of the skin and mucous membranes.
Cough with pulmonary edema, it occurs reflexively due to an increase in the concentration of carbon dioxide in the blood ( with pulmonary edema, the process of gas exchange is disrupted). Initially, the cough may be painful and without discharge ( unproductive), but then pink sputum is added to it.
Producing pink and frothy sputum occurs when there is a large amount of fluid in the lungs. Sputum is pink in color due to the fact that it contains red blood cells, which are from the capillaries ( tiny vessels) entered the alveoli. Also, sputum due to foaming of the liquid in the alveoli acquires a specific consistency ( becomes frothy). So, from 100 ml of blood plasma that has entered the lungs, 1 - 1.5 liters of foam is obtained.
Wheezing initially dry ( fluid in the lungs compresses the small caliber bronchi), but in a short period of time they become wet, due to the accumulation of a large amount of fluid in the bronchi. On auscultation, small, medium, and coarse bubbling rales can be heard ( wheezing occurs in small, medium and large bronchi).
Blueness of the skin and mucous membranes is a characteristic sign of pulmonary edema and occurs due to the accumulation of large amounts of reduced hemoglobin ( protein that carries carbon dioxide and oxygen) in the superficial vessels of the skin and mucous membranes, which gives such a color.
It should be noted that pulmonary edema can occur in children of all age groups, including newborns. Most often, pulmonary edema occurs against the background of any pathology that leads to hypoxia ( oxygen starvation). With a decrease in the concentration of oxygen in the blood, the permeability of the walls of the alveoli increases, which is one of the most important links in the mechanism of the development of pulmonary edema. Also, the heart muscle and brain are extremely sensitive to hypoxia.
In newborns, pulmonary edema may occur against the background of the following pathologies:
- placental infarction is the death of cells in a certain area of the placenta. The most dangerous placental infarction is in the III trimester of pregnancy, since it is during this period that this pathology can significantly affect intrauterine development. With myocardial infarction, the blood supply to the fetus is disrupted, which can lead to hypoxia.
- Aspiration of amniotic fluid- entry into the lower respiratory tract ( bronchi and alveoli) amniotic fluid. In the intrauterine period, amniotic fluid penetrates up to the bifurcation of the trachea ( division of the trachea into right and left bronchus). If a significant amount of this fluid enters the respiratory system, there may be a high probability of pulmonary edema.
- Prenatal or birth trauma of the brain often leads to impaired blood supply to the brain. Prolonged oxygen starvation of the cells of the central nervous system causes reflex changes in blood supply throughout the body ( heart muscle, lungs, liver, kidneys). In the future, prolonged hypoxia causes pulmonary edema.
- Heart defects also cause pulmonary edema. With aortic valve stenosis, as well as mitral valve insufficiency, pressure in the pulmonary circulation ( blood vessels that carry blood from the lungs to the heart and vice versa) increases significantly. These heart defects lead to the release of blood plasma from the capillaries ( tiny vessels) into the intercellular substance of the lungs, and later into the alveoli themselves.
How to provide emergency care for pulmonary edema?
Pulmonary edema is a rather severe pathology and therefore requires immediate assistance. There are several general rules for providing emergency care for pulmonary edema. Emergency care for pulmonary edema involves the following activities:
- Place the patient in a semi-sitting position. If a person begins to experience symptoms of pulmonary edema, he should immediately be seated in a semi-sitting position with his legs down. In this position, stagnation in the pulmonary circulation is reduced to a certain extent ( blood vessels that carry blood from the lungs to the heart and vice versa), which manifests itself in the form of a decrease in shortness of breath. Also in this position, the pressure in the chest decreases and the process of gas exchange improves.
- The use of venous tourniquets. Venous tourniquets must be applied to the lower limbs. The duration of the application of tourniquets should be from 20 to 30 minutes. The tourniquet is applied with medium force on each leg in the region of the upper third of the thigh so that only the veins are compressed ( the pulse of the femoral artery should be felt). This manipulation is carried out in order to reduce the flow of venous blood to the heart and, accordingly, reduce the severity of the clinical manifestations of pulmonary edema.
- Open access to fresh air. Staying in a stuffy room aggravates the course of pulmonary edema. The thing is that with a low oxygen content in the air, the permeability of the alveoli increases ( special sacs in which gas exchange occurs). This leads to the fact that the liquid from the capillaries ( the smallest vessels that, together with the alveoli, participate in the process of gas exchange) rushes first into the intercellular space of the lungs, and then into the alveoli themselves ( pulmonary edema develops).
- Use of nitroglycerin. Nitroglycerin is indicated when pulmonary edema has been caused by myocardial infarction ( most common cause of pulmonary edema). It is recommended to take 1 or 2 tablets under the tongue with an interval of 3 to 5 minutes. Nitroglycerin reduces venous congestion in the lungs and also dilates the coronary arteries that feed the heart.
- Alcohol vapor inhalation. Inhalation of alcohol vapors quite effectively neutralizes foaming during pulmonary edema. Foam is produced due to the rapid accumulation of fluid in the alveoli. A large amount of foam greatly complicates the process of gas exchange, as it leads to blockage of the respiratory system at the level of the terminal ( terminal) bronchi and alveoli. Adults and children need to inhale vapors of 30% ethyl alcohol.
- Continuous monitoring of heart rate and respiration. It is necessary to constantly monitor the respiratory rate, as well as the pulse of a patient with pulmonary edema. If necessary, perform cardiopulmonary resuscitation immediately ( chest compressions and/or artificial respiration).
Can pulmonary edema be cured?
Pulmonary edema is a dangerous pathology that requires immediate and qualified medical care. The success of treatment depends on the form of pulmonary edema ( cardiogenic or non-cardiogenic pulmonary edema), severity, the presence of concomitant diseases ( chronic heart failure, heart defects, hypertension, renal and hepatic failure, etc.), as well as how quickly and fully medical care was provided. Regardless of the cause that led to pulmonary edema, a number of therapeutic measures are performed in the intensive care unit aimed at stopping ( elimination) pain sensations, a decrease in the degree of oxygen starvation, a decrease in the volume of circulating blood, a decrease in the load on the heart muscle, etc.
Urgent care for pulmonary edema
| Therapeutic activities | Mechanism of action |
| Taking narcotic pain medications morphine). Morphine should be given at 10 milligrams intravenously in divided doses. | These medicines help to eliminate shortness of breath and relieve psycho-emotional stress ( reduce the production of adrenaline and norepinephrine). Also, morphine leads to a moderate expansion of the veins, which leads to a decrease in the severity of the clinical symptoms of pulmonary edema. |
| oxygen therapy ( oxygen inhalation) with ethyl alcohol vapor at a rate of 3 - 6 liters per minute. | Significantly reduces hypoxia ( oxygen starvation). Hypoxia has an extremely unfavorable effect on the vessels of the lungs, increasing their permeability, as well as increasing stagnation in the pulmonary circulation ( blood vessels that carry blood from the heart to the lungs and vice versa). Oxygen therapy is one of the most important measures and is prescribed for any type of pulmonary edema ( with cardiogenic and non-cardiogenic). |
| Taking nitrates ( nitroglycerine) inside 1 - 2 tablets in 3 - 5 minutes. Intravenous administration of up to 25 mcg bolus is also possible ( rapid introduction of the entire contents of the syringe), and then drip administration with increasing dose. | Nitrates to a certain extent reduce the stagnation of venous blood in the lungs, due to the expansion of the walls of the veins. In large doses, nitrates are able to expand the coronary vessels that feed the heart. Also, these drugs reduce the load on the myocardium ( muscle layer) of the left ventricle. It should be noted that the use of nitrates is necessary only when pulmonary edema was caused by myocardial infarction ( most common cause of pulmonary edema) and is strictly prohibited in hypertensive cardiomyopathy ( thickening of the muscle layer of the left ventricle). |
| Taking diuretics ( furosemide). The drug is administered intravenously in a single dose of 40 milligrams. In the future, furosemide can be re-introduced. | diuretic drugs ( diuretics) cause a decrease in circulating blood volume. At first, furosemide slightly dilates the veins ( causes venodilation), and then, acting on the renal tubules, has a diuretic effect ( enhances the excretion of sodium, calcium, magnesium and chlorine ions). With intravenous use, the therapeutic effect is observed after 10 minutes, and when taken orally ( tablet form) - within 30 - 60 minutes. |
| Taking ACE blocking drugs angiotensin converting enzyme). This group of drugs enalaprilat) are administered intravenously in a single dose of 1.25 to 5 milligrams. | ACE blockers to a certain extent reduce the volume of circulating blood by reducing the level of a special enzyme angiotensin. This enzyme not only constricts blood vessels, but also increases the production of the hormone aldosterone, which causes fluid retention in the body. These drugs can dilate arterioles ( small caliber arteries) and thereby reduce the load on the left ventricle of the heart. |
In addition to the above measures, treatment should also be directed to the cause that caused the pulmonary edema.
Scheme for the treatment of pulmonary edema depending on the cause and blood pressure
| Pathological condition | Treatment regimen |
| myocardial infarction | To eliminate the pain syndrome, 10 milligrams of morphine is administered intravenously fractionally. To reduce the risk of blood clots, give 250-500 milligrams of aspirin to chew, and then 5000 units are injected intravenously ( international units) heparin. In the future, the treatment algorithm depends on the blood pressure indicators. |
| Hypertensive crisis
(pronounced increase in blood pressure) | Under the tongue 1 or 2 tablets of nitroglycerin ( the second tablet with an interval of 3 - 5 minutes). Nitroglycerin reduces blood pressure, and to some extent reduces the insufficiency of the left ventricle of the heart. Also, in a hypertensive crisis, furosemide is administered intravenously ( diuretic) 40 - 80 milligrams ( more effective repeated administration of small doses). In addition, intravenous enalaprilat is prescribed to lower blood pressure ( ACE blocker) at 1.25 - 5 milligrams. To reduce pain, 10 milligrams of morphine is injected intravenously. |
| Hypotension
(lowering blood pressure below 90/60 mmHg) | To enhance cardiac activity and increase blood pressure, dobutamine is administered intravenously at a rate of 2.5 to 10 μg / kg per minute. Gradually increase the dose until stabilization of systolic blood pressure ( 90 or more mm Hg. Art.). In the future, nitroglycerin and morphine are administered intravenously. |
| Anaphylactic shock
(immediate allergic reaction) | In the first minutes, it is necessary to inject 5 milliliters of a 0.1% solution of adrenaline intramuscularly ( if there is no effect, the dose can be re-introduced after 5 to 10 minutes). Adrenaline in a short time eliminates the excessive expansion of the veins. It is also able to expand the airways and affect the heart muscle, increasing its contractile function. Be sure to introduce glucocorticoids, which significantly reduce the concentration of immunoglobulins ( special proteins) and histamine ( biologically active substance) that support the allergic reaction. Prednisolone is prescribed intravenously in high doses - at least 150 mg ( or dexamethasone 20 mg), since in smaller doses the drug is ineffective. To relieve pain, morphine is administered intravenously in an amount of 10 milligrams fractionally. In addition to these medications, furosemide is also prescribed ( 40 mg IV) and aminofillin, which dilates the bronchi and also reduces pulmonary edema ( 2.4% solution 10 - 20 milliliters intravenously). |
Treatment should be carried out until the following conditions are met:
- normalization of blood pressure ( upper pressure should not be higher than 140 and lower than 90 mm Hg. Art.);
- normalization of the number of heartbeats ( the norm is from 60 to 90 beats per minute);
- decrease in respiratory rate to 22 or less in one minute;
- absence of wet rales when listening ( auscultation) lungs;
- lack of sputum and foam;
- normalization of skin color and mucous membranes;
- absence of symptoms of pulmonary edema when the patient moves to a horizontal position.
ALGORITHM FOR PROVIDING EMERGENCY AID. ACUTE LEFT VENTRICULAR FAILURE
Acute left ventricular failure (ALHF) manifests itself in the form of cardiac asthma and pulmonary edema. First, fluid accumulates in the interstitial tissue of the lung (in the interstitial gaps) - cardiac asthma. and then the edematous fluid sweats into the alveoli - pulmonary edema. Thus, cardiac asthma and pulmonary edema are two successive phases of acute left ventricular failure.
The cause of acute left ventricular failure may be heart disease (cardiac OLZHN). It develops in connection with a decrease in the contractility of the left ventricular myocardium with coronary artery disease, mitral stenosis, arrhythmias, aortic heart disease, cardiomyopathies, and severe myocarditis.
extracardiac acute left ventricular failure occurs due to overload of the heart with increased BCC and blood pressure in hypertension, symptomatic hypertension, chronic renal failure.
Factors that provoke an attack: 1. psycho-emotional stress, 2. inadequate physical activity, 3. weather change 4. geomagnetic disturbances, 5. excess salt in food 6. drinking alcohol, 7. taking corticosteroids, anti-inflammatory non-steroids, sex hormones, 8. pregnancy, 9. premenstrual syndrome, 10. violation of urodynamics, 11. exacerbation of any chronic disease, 12 cancellation of cardiotonic, b-blockers.
Clinic: paroxysm of cardiac asthma occurs more often at night or during the day in the supine position. Inspiratory dyspnea appears (RR up to 30-40 per minute), turning into suffocation, which makes the patient sit or stand up. The face is pale and then bluish, covered with sweat, contorted with fear. The attack is accompanied by a cough with copious liquid sputum. Speech is difficult due to coughing. Hand tremors and hyperhidrosis are observed. On auscultation, moist rales over the entire surface of the lungs. The appearance of bubbling breath and cough with pink frothy sputum indicates the onset of pulmonary edema.
Complications: 1. cardiogenic shock, 2. asphyxia.
Differential Diagnosis carried out with an attack of bronchial asthma and other variants of broncho-obstructive syndrome.
EMERGENCY AID ALGORITHM
Pulmonary edema, emergency care
Pulmonary edema- severe pathological condition sweating of plasma, blood into lung tissue. leads to respiratory failure.
It is observed in acute and chronic heart failure, pneumonia, coma, brain tumors, anaphylactic shock, Quincke's edema, poisoning, head and chest injuries, intracranial hemorrhages, plague and other infectious diseases.
Clinic
Shortness of breath, cough, bubbling breath, frothy sputum with blood, a feeling of constriction and pain in the heart, anxiety, agitation, pale skin, cold sticky sweat, cyanosis, auscultatory - an abundance of moist rales in the lungs, dullness of percussion sound.
Urgent Care
1. Give the patient a semi-sitting position.
2. Suction mucus from the upper respiratory tract.
3. Carry out inhalation with vapors of 70% ethyl alcohol.
4. Apply a tourniquet to the lower limbs.
5. According to the doctor's prescription, enter: 1% solution of lasix - 4.0 intravenously or intramuscularly, if there is no effect, again after 20 minutes, increasing the dose, 2.4% solution of aminophylline - 10 ml intravenously by stream, 0.05% solution of strophanthin - 0 5-1 ml in an isotonic solution of sodium chloride intravenously bolus slowly.
6. Prednisolone 60 mg intravenously.
7. 5% solution arfonade- 100 ml per 200 ml of isotonic solution intravenously drip slowly.
8. 0.25% solution of droperidol - 2.0 in 20% glucose solution intravenously by bolus.
9. 2.5% solution of a mixture of chlorpromazine - 0.5 ml, 2.5% solution of pipolfen - 1.0 ml intravenously by bolus in 20 ml of 40% glucose solution.
10. 5% solution of ascorbic acid - 4 ml, 1% solution of nicotinic acid - 1 ml.
11. 4% sodium bicarbonate solution - 2 mg/kg intravenously by bolus.
12. 7.5% solution of potassium chloride - 15-20 ml intravenously drip.
Pulmonary edema
Pulmonary edema is an excessive accumulation of fluid in the extravascular space of the lungs, accompanied by a violation of gas exchange and acute respiratory failure.
Classification
The modern classification of pulmonary edema is based on differences in its pathogenesis. Two main types can be distinguished:
- cardiogenic or hydrostatic
- non-cardiogenic, or edema due to increased permeability of the alveolar membrane
- mixed forms of edema (usually neurogenic)
- pulmonary edema due to other, rarer causes
Causes
Increased pulmonary capillary transmural pressure.
- Left ventricular failure, acute or chronic.
- Myocardial infarction or ischemia.
- Severe hypertension.
- Aortic stenosis or insufficiency.
- Hypertrophic cardiomyopathy.
- Myocarditis.
- Mitral valve stenosis or severe mitral regurgitation.
- Over-infusion therapy.
Increased permeability of the endothelium of the pulmonary capillaries.
- Infection (bacteremia, sepsis).
- Inflammation.
- Disseminated intravascular coagulation.
- Allergic reaction.
- Iatrogenic damage (opiates, salicylates, chemotherapy, radiopaque drugs).
- ARDS.
Increased permeability of the alveolar epithelium.
- Inhalation of toxic substances.
- Allergic reaction.
- Aspiration, drowning.
- Surfactant deficiency.
Decreased plasma oncotic pressure.
- Hypoalbuminemia.
- nephrotic syndrome.
- Liver failure.
Impaired outflow of plasma.
- Lymphangitis.
- After lung transplant.
mixed mechanism.
- Neurogenic pulmonary edema.
- Altitude sickness.
- Postoperative pulmonary edema.
Knowing the cause of pulmonary edema is important when choosing priority treatments. Issues of clinical physiology, diagnosis and treatment of non-cardiogenic pulmonary edema are similar to those of ARDS.
Clinical physiology of pulmonary edema
According to Starling's law, the movement of fluid from the capillaries to the interstitium and vice versa depends on the difference in hydrostatic and oncotic pressures on both sides of the vascular wall, as well as on the permeability of the wall itself.
Initially, when the CVL increases due to the interstitium of the lungs, hypoxia occurs without hypercapnia, which is easily eliminated by oxygen inhalation, since it is associated only with a thickening of the alveolo-capillary membrane and a violation of the diffusion of gases through it. If, despite the inhalation of oxygen, hypoxemia persists, then this is due to the onset of alveolar shunting of the blood.
Due to mucosal edema, the lumen of the respiratory tract narrows, and the bronchioles lose their elasticity, an alveolar shunt develops, which increases respiratory failure.
In addition, increased muscle effort is required to open the blood-filled, edematous lungs. At the same time, the work of the respiratory muscles increases and the oxygen price of respiration increases. Hypoxia intensifies, therefore, the permeability of the alveolocalillary membrane increases even more, and fluid extravasation may occur, i.e. pulmonary edema. Hypoxemia-associated catecholaminemia blocks lymphatic drainage - lung stiffness increases even more.
In all patients with decompensated left ventricular failure, a functional study reveals signs of obstructive and restrictive disorders:
- static volumes of the lungs, including their total capacity, are reduced;
- forced expiratory volume is usually no more than half of the proper value;
- indicators of the curve "flow - maximum expiratory volume" are sharply reduced.
As pulmonary edema develops, plasma extravasation occurs, and then the main mechanism of respiratory failure is the blockage of the airways by foam, which is formed when plasma foams in the atveoli. The same pricing serves as the main physiological mechanism for respiratory failure in normal (non-cardiogenic) pulmonary edema, although intensive care for these respiratory forms varies significantly.
Emergency Diagnostics
Pulmonary edema can be due to various causes, but it is not easy to differentiate them due to similar symptoms.
Symptoms of pulmonary edema are not specific. Most often, pronounced shortness of breath is noted as a manifestation of interstitial edema, tachypnea, cyanosis, participation of auxiliary muscles inhalation, i.e. clinical signs of respiratory failure. At the first stage of pulmonary edema, auscultation reveals dry rales of narrowing of the airways against the background of peribronchial edema. As the edema develops, moist rales appear, more pronounced in the basal regions.
Chest x-ray should be performed for everyone with pulmonary edema, it allows you to identify the phases of interstitial and alveolar edema, changes in the size of the heart.
The diagnostic accuracy of chest x-ray in pulmonary edema is limited for a number of reasons. First, swelling may not be visible until the amount of fluid in the lungs has increased by 30%. Secondly, many of the X-ray signs are not specific, and may be characteristic of other pulmonary pathologies. Finally, one cannot ignore the technical difficulties, including respiratory movements, patient position, positive pressure ventilation.
Echocardiography evaluates myocardial function, the condition of the valves, helping to determine the cause of pulmonary edema. Doppler echocardiography can assess diastolic pressure and reveal diastolic dysfunction.
Diagnostic algorithm for pulmonary edema
We present a diagnostic algorithm for managing a patient with pulmonary edema in emergency pulmonology.
Stage I - Anamnesis, physical examination, laboratory examination
Stage II - Chest X-ray
If the diagnosis is not clear
Stage III - Transthoracic or transesophageal echocardiography
emergency therapy
Elimination of the factors that cause pulmonary edema is an obligatory component of treatment tactics.
Elimination of fear, catecholaminemia with the help of neuroleptics is an important universal measure of intensive care for pulmonary edema.
Intensive care measures can be divided into the following groups:
- defoaming;
- elimination of plethora;
- increase in cardiac output;
- stimulation of diuresis;
- respiratory therapy.
Since pulmonary edema is a critical condition requiring urgent life support measures, the listed measures sometimes have to be performed against the background of mechanical ventilation and oxygen therapy.
Defoaming
If foaming in the lungs and airways is severe, defoaming is considered the most urgent measure. The most studied means for this purpose is inhalation of ethyl alcohol vapors.
Since ethyl alcohol can cause bronchospasm, oxygen is first given, which "bubbles" through 96% ethyl alcohol and is added through a catheter to the mixture inhaled by the patient. If there is no negative reaction, you can try aerosol inhalation of 30-60% alcohol for 2-3 minutes with monitoring of effectiveness after each session.
Defoaming can also be achieved by intravenous administration of 30-40% ethanol (15-30 ml). Alcohol is released into the alveoli and quenches the foam.
Eliminate pulmonary congestion and increase cardiac output
To do this, it is necessary to increase the output of the left ventricle: normalize the levels of plasma and cellular potassium, eliminate metabolic acidosis, and use cardiac glycosides already against this background.
Morphine is used to reduce peripheral resistance. At the same time, the configuration of the left ventricle changes, which makes its contractions more efficient, and the volume of blood is redistributed from the pulmonary circulation to the large one. However, this effect of morphine occurs at significant doses that depress respiration.
In intensive care, the initial level of blood pressure is of particular importance. The choice of inotropic support in patients with pulmonary edema directly depends on the level of blood pressure.
The level of arterial pressure serves both as an indicator of the effectiveness of treatment and as a prognostic indicator. When it is elevated, the efficacy of treatment is high, and a positive result occurs quite quickly with the infusion of sodium nitroprusside and other vasodilators. Baseline low blood pressure is an unfavorable prognostic sign, since the use of dopamine in these patients to maintain sufficient tissue perfusion may exacerbate left ventricular failure.
Stimulation of diuresis
Furosemide is used, which helps to reduce VOVL, which reinforces the beneficial effect of previous measures.
The lungs become less rigid, their opening requires less effort of the respiratory muscles, oxygen homeostasis improves, which means that the permeability of the alveolo-capillary membrane and interstitial pulmonary edema decrease.
Respiratory Therapy
The primary measure is the inhalation of oxygen in combination with spontaneous ventilation in the PEEP mode. These regimens increase intrapulmonary pressure, decrease lung congestion, and improve lung compliance. The gas exchange area increases, sputum evacuation is facilitated, i.e. the main mechanisms of respiratory failure are eliminated.
If the PEEP mode is ineffective during spontaneous ventilation for 30-60 minutes, mechanical ventilation should be performed. The level of PEEP during mechanical ventilation with pulmonary edema should be at least 8 cm of water.
Emergency Help - Algorithm
When foaming in the lungs, inhalation of ethyl alcohol vapors is indicated, and if bronchiolospasm does not occur on them, short-term (2-3 minutes) inhalation of an aerosol of 30-60% ethyl alcohol is carried out.
To reduce the plethora of the lungs, cardiac glycosides are shown after the normalization of the acid-base and electrolyte state, dobutamine.
To lower peripheral vascular resistance - morphine, nitrates under the control of blood pressure.
PEEP mode during spontaneous breathing - early non-invasive respiratory support.
With its insufficient efficiency - IVL through an endotracheal tube in a moderate PEEP mode.
Pulmonary edema is a pathological process, the occurrence of which is associated with the release of transudate of non-inflammatory origin from the capillaries into the interstitium of the lung, and then into the alveoli. The result of this process is a reduced performance of the alveoli and a violation of gas exchange, hypoxia is formed. Significant changes also occur in the gas composition of the blood, as the content of carbon dioxide increases. In combination with hypoxia, the patient has a strong suppression of the central nervous system. All this requires immediate medical attention, otherwise the consequences can be the most deplorable.
Symptoms
If the symptoms of pathology are determined in time, then emergency care for pulmonary edema will significantly reduce the risk of complications. If the disease is in an advanced phase, then the patient has difficulty breathing due to shortness of breath. It does not matter what state the patient is in: he is doing physical activity or just lying down.
Pulmonary edema is a pathology that leads to oxygen starvation, which negatively affects the work of other organs. During examination with a stethoscope, wheezing may be heard, indicating the accumulation of fluid in the alveoli.
In addition, pulmonary edema can be recognized by the following symptoms:
- Dizziness is a common symptom of pathology.
- Often, against this background, the patient develops drowsiness and apathy.
- If the disease takes a lightning-fast form, then this is fraught with suffocation, which affects a person at night.
- Cough, the formation of sputum, which eventually becomes very thin and resembles ordinary water.
- Complicated breathing, the presence of wheezing and whistling.
- Paleness of the skin and increased sweating.
Very often, a person, against the background of a disease, happens associated with thoughts of death. The duration of the attack is 30 minutes, so first aid is very important at this time. Only with its correct implementation it is possible to avoid the death of the victim.
Classification of pathology
In addition to these symptoms for proper first aid, it is important to know the types of pulmonary edema:
- Membraneogenic - is formed against the background of a sharp increase in capillary permeability. Such a pathology is formed against the background of other syndromes.
- Hydrostatic - affects due to diseases, which are characterized by a sharp increase in hydrostatic pressure in the vessels. The liquid part of the plasma can be released in such a volume that it cannot be removed through the lymphatic tract.
Proper condition assessment
Taking into account the rate of transformation of the interstitial stage of edema into the alveolar stage, it is necessary to assess the condition of the victim. If there are chronic diseases, then the development of edema is slow and smooth, more often at night. Such a pathological process can be eliminated without problems with medicinal drugs. If the edema is caused by defects in the mitral valve, damage to the pulmonary parenchyma, then an increase in its symptoms is observed. The patient's condition is deteriorating markedly. Pathology in an acute form involves a quick response and first aid, since its development is very rapid.
First aid
Having found signs of a pathological process in a person, it is necessary to immediately begin to provide emergency care. In this case, first aid for pulmonary edema involves the following algorithm of actions:
- Place the victim in a semi-sitting position.
- Remove foam from the upper respiratory tract. For these purposes, it is necessary to use oxygen inhalation through 33% ethanol.
- Relief of acute pain syndrome. In resolving this issue, neuroleptics will help.
- Restore the rhythm of the heart.
- Correct electrolyte balance.
- Normalize the acid-base balance.
- Regulate hydrostatic pressure in the pulmonary circulation. To do this, use such narcotic analgesics as Omnopon, Promedol. Their action is aimed at inhibiting the respiratory center, eliminating tachycardia, reducing blood flow in the veins, lowering blood pressure, reducing anxiety and fear of death.
- Give the victim vasodilators. Nitromint aerosol has an excellent effect. When using it, it is possible to reduce vascular tone, intrathoracic plasma volume. With the use of nitroglycerin preparations, it is possible to facilitate the outflow of blood from the lungs by acting on peripheral vascular resistance.
- The application of venous tourniquets on the lower extremities. Such measures should be carried out in order to reduce the CTC. This method has been actively used for several decades. To dehydrate the lung parenchyma, Lasix is used in an amount of 40 ml. It is administered intravenously. Its action is achieved within a couple of minutes, and lasts 3 hours. The drug is able to remove 2 liters of urine in a short time. With a reduced blood volume and increased colloid osmotic pressure, the edematous fluid passes into the bloodstream. The filtration pressure drops. Giving diuretics to the victim is allowed only after the blood pressure has returned to normal.
- The introduction of cardiac glycosides in order to increase myocardial contractility.
- Urgent hospitalization.
Consequences of an ambulance
Often, when providing first aid to a patient, the condition can, on the contrary, worsen and cause a number of the following complications:
- Formation of a fleeting form of pathology.
- Frequent production of foam causes airway obstruction.
- Respiratory depression.
- Anginal pain. Such a pain syndrome becomes simply unbearable, so the patient may develop a pain shock that negatively affects the overall prognosis.
- BP cannot stabilize. Often, the course of pathology occurs against the background of low and high blood pressure. Indicators can alternate within a significant amplitude. The vessels cannot withstand such a load, therefore, a deterioration in the patient's condition is noted.
Therapy of the disease
After providing first aid, the patient must be urgently hospitalized. Already in a hospital, the victim will be prescribed the following treatment:
- Oxygen inhalation in combination with ethyl alcohol. Such activities will help remove foam from the lungs.
- Pain medications and medicines to reduce psychomotor agitation. To reduce hydrostatic pressure in the vessels of the affected organs and reduce the flow of venous blood, Morphine or Fentanyl is prescribed.
- Diuretics, the action of which is aimed at reducing the volume of moving blood. Furosemide is considered effective, which dehydrates the lungs.
- Cardiac glycosides help achieve a cardiotonic effect. Assign Strofantin and Korglikon.
- To remove bronchospasm and for prevention, the patient is taking Eufillin and Aminophylline.
- If there is an infectious disease, then broad-spectrum antibiotics cannot be dispensed with.
Pulmonary edema is a very serious and dangerous disease, since if an ambulance is not provided, there is a risk of death. If all therapeutic measures were carried out on time and correctly, then you should not worry, because after effective therapy prescribed by a doctor, the condition of the victim will noticeably improve.
First aid for pulmonary edema is a necessary measure to maintain human life.
First aid is a set of measures that are aimed at eliminating acute symptoms and providing life support.
If pulmonary edema occurs, then first aid consists in calling an ambulance, since out-of-hospital conditions rarely have all the necessary medicines and devices. While waiting for qualified doctors, people around the patient must take the necessary measures.
Pulmonary edema: clinic and emergency care
Pulmonary edema is a condition where too much fluid builds up in the lungs. This is due to the large difference in the indicators of colloid osmotic and hydrostatic pressure in the capillaries of the lungs.
There are two types of pulmonary edema:
Membraneogenic- occurs if the permeability of capillaries has increased sharply. This type of pulmonary edema often occurs as an accompaniment to other syndromes.
Hydrostatic- develops due to diseases in which the hydrostatic capillary pressure rises sharply, and the liquid part of the blood finds an outlet in such an amount that it cannot be removed through the lymphatic pathways.
Patients with pulmonary edema complain of lack of air, have frequent shortness of breath and sometimes attacks of cardiac asthma that occur during sleep.
The skin is pale, and from the side of the nervous system there may be inadequate reactions in the form of confusion or its depression.
With pulmonary edema, the patient has a cold sweat, and when listening to the lungs, wet rales are found in the lungs.
At this time, it is very important to act quickly and accurately, because in the absence of support, the situation can deteriorate dramatically.
When the ambulance arrives, all the actions of the specialists will be aimed at three goals:
- reduce the excitability of the respiratory center;
- relieve the load of the pulmonary circulation;
- remove foam.
In order to reduce the excitability of the respiratory center, the patient is injected with morphine, which relieves not only pulmonary edema, but also an asthma attack. This substance is not safe, but here it is a necessary measure - morphine selectively affects the brain centers responsible for breathing. Also, this medication makes the blood flow to the heart not so intense and due to this, stagnation in the lung tissue is reduced. The patient becomes much calmer.
This substance is administered either intravenously or subcutaneously, and after 10 minutes its effect occurs. If the pressure is lowered, promedol is administered instead of morphine, which has a less pronounced, but similar effect.
Strong diuretics (such as furosemide) are also used to relieve pressure.
To unload the circle of small blood circulation, they resort to a dropper with nitroglycerin.
If there are symptoms of impaired consciousness, then the patient is given a weak antipsychotic.
Together with these methods, oxygen therapy is indicated.
If the patient has developed persistent foam, then this treatment will not give the desired effect, as it can block the airways. To avoid this, doctors give inhalation with 70% ethyl alcohol, which is passed through oxygen. Then the specialists suck out excess fluid through the catheter.
If pulmonary edema is suspected, emergency care should be provided to the patient immediately. Otherwise, complications such as asphyxia, shock, pulmonary insufficiency, collapse, and even death may develop.
Clinical picture of pulmonary edema
Usually this pathology develops in the same way. However, the place of accumulation and the amount of pathological fluid determine the severity of symptoms of pulmonary edema. Assessing the severity of the disease process, in medical practice, 4 phases of the course of the disease are distinguished.
Clinically important manifestations of the disease are:
- There is dyspnea - difficulty breathing. The number of respiratory movements increases sharply. Shortness of breath, even at rest, is the main sign of an increase in the volume of fluid in the paired respiratory organ. The patient complains of attacks of lack of air, a feeling of tightness in the chest.
- Since sputum begins to stand out, shortness of breath is a protective mechanism of the body in conditions of severe disruption of gas exchange. Breathing becomes much harder when the patient's condition worsens.
- An abnormally rapid heartbeat is noted - a sign of severe tachycardia. Specialists register up to 120 contractions per minute.
- Since fluid accumulates in the pleural cavity, bubbling breathing is heard even at a distance. Wet rales come from the chest. Intermittent cough appears as the situation worsens. Since there is an accumulation of mucus inside the paired respiratory organ, with this ailment, there is a discharge from the chest of a foamy thick mucous sputum (sputum).
- In a liquid pathological secret of a pinkish color, streaks of blood may appear. Extracellular fluid with foam comes from the chest through the nose if the pathology is severe. Breathing becomes shallow. The patient catches air with his mouth, constantly suffocating.
- Due to an acute lack of oxygen in the chest, a pressing, squeezing pain is felt. In the center of the chest or in its lower part, an intense pain syndrome occurs.
- Violation of blood circulation causes the development of diffuse cyanosis. There is a bluish coloration of the upper body, face. White tongue. The skin is covered with drops of cold sweat. Often a whistle comes from the chest.
- Due to shortness of breath, the patient has to stay in a standing or sitting position. A very characteristic forced posture is orthopnea (orthopnoe.) The patient experiences a fear of death. Panic develops.
- Often, collapse develops very quickly - blood pressure drops rapidly. Pulse intermittent, weak. The patient has a deterioration in health.
- When the patient is lying down, congestion in the lungs increases. All symptoms of edema increase. If the patient is not provided with competent medical care, the patient chokes and dies, unable to breathe.
- With pulmonary edema of any kind, immediate treatment is always required, since the patient often has a fainting state with a transition to a coma.
Providing emergency care
The prognosis for this pathology largely depends on how quickly first aid is provided. Prior to the arrival of the ambulance team, emergency care for pulmonary edema should be carried out according to the following algorithm:
- it is convenient to seat the patient;
- release the body from restrictive clothing (shirt, tie);
- put a tourniquet on the limbs;
- provide access to clean air;
- give the patient a tablet of Nitroglycerin and Aspirin;
- evaluate breathing and heart rate.
First aid can be provided by the patient himself, his relatives or people passing by. It is very important to give a person the right posture. This is necessary in order to reduce congestion in the pulmonary circulation.
The most optimal posture is half-sitting with legs down.
This reduces shortness of breath and alleviates the patient's condition. In a half-sitting position, pressure in the chest cavity decreases.
First aid includes the application of tourniquets. They are located in the upper third of the thigh.
The pulse must be preserved. The purpose of this manipulation is to reduce the load on the heart.
With edema, hypoxemia develops. To saturate the blood with oxygen, you need to provide an influx of clean air.
To do this, open the window, window or door.
Emergency care includes the use of nitrates. These drugs dilate the coronary arteries, thereby improving the blood supply to the myocardium. Nitroglycerin is especially effective if the edema has developed against the background of an acute heart attack. Additionally, you can organize a foot bath.
If the patient foams at the mouth or coughs up pink sputum, it is recommended to breathe in ethyl alcohol vapors. You can use an inhaler for this. In case of cardiac arrest, resuscitation is required.
When performing an indirect heart massage, the frequency of chest compressions should be at least 100 per minute.
Emergency assistance in extreme conditions. Video
Therapeutic tactics for edema
At home and during transportation to the hospital, specialists provide professional assistance:
- Reduce venous inflow by applying tourniquets to the limbs. After 20 minutes, the venous tourniquets are removed, gradually loosening them.
- With the help of suction and inhalation of 100% oxygen from the upper respiratory tract, fluid is slowly pumped out of the lungs. For this, oxygen therapy is performed.
- Carry out inhalation with ethyl alcohol.
- The diuretic Lasix is administered intravenously.
- It is important to reduce the fear of death, lower blood pressure with the help of ganglionic blockers, and relieve tachycardia. For this, narcotic analgesics are used.
- With collapse, inotropic drugs are administered.
Diagnostics
In a hospital, a preliminary diagnosis is made on the basis of the results of research, examination and questioning of the patient. After emergency care is provided, laboratory tests are carried out. If edema is suspected, the following studies are required:
- assessment of the gas composition of the blood;
- Ultrasound of the heart;
- general clinical blood and urine tests;
- biochemical research;
- coagulogram;
- catheterization;
- electrocardiography;
- x-ray study.
The degree of hypoxia can be determined by determining the concentration of oxygen and carbon dioxide in the blood. In the early stages of edema, hypercapnia is detected, then the partial pressure of oxygen and carbon dioxide decreases. The reaction of the environment also changes. Respiratory alkalosis develops. The central venous pressure increases.
Electrocardiographic signs of edema are represented by an increase in the left ventricle, rhythm disturbances and tissue ischemia. Pulmonary artery catheterization helps determine the cause of the edema. Be sure to measure blood pressure and conduct auscultation. Of great importance is the collection of anamnesis of the disease. If there are indications of cardiac pathology in the medical history, then edema can be suspected.
Therapeutic measures
In a hospital setting, it is important to immediately perform the following therapeutic measures:
- restoration of hydrostatic pressure parameters;
- normalization of electrolyte balance;
- regulation of the heart rate;
- correction of acid-base balance;
- the outflow of blood from the lungs is facilitated with the help of Nitroglycerin;
- vascular tone is lowered by vasodilators;
- Albumin is administered intravenously if an insufficient protein content is detected;
- steroid hormones Dexamethasone, Prednisolone have a good effect.
An important aspect of the treatment of patients is the use of diuretics (diuretics). The most commonly used is Lasix. It is available in tablet and solution form. This drug should not be used in severe hypotension, cardiomyopathy and valvular stenosis. There are other contraindications. With high blood pressure, ganglionic blockers are often prescribed.
These medicines reduce the workload on the heart. Blood rushes to the limbs. Ganglioblockers include Pentamine and Benzohexonium. If there is a collapse (decrease in blood pressure), then first aid includes the use of Dopamine or Dobutamine. With severe pain syndrome, analgesics are indicated. In severe cases, opioid receptor agonists (Promedol) are used.
Pulmonary edema develops predominantly in the elderly.
Weakened immunity and possible concomitant diseases in such patients aggravate their condition and prognosis.
After hospitalization and diagnosis, the optimal treatment regimen is selected. Oxygen therapy is carried out. Narcotic analgesics are prescribed. They allow you to get rid of pain. Neuroleptanalgesia is often performed. It allows you to calm the sick person. To normalize the work of the heart, dehydration is carried out with the help of diuretics. In the presence of symptoms of acute heart failure, it is advisable to use Strofangin or Korglikon.
If the swelling has led to bronchospasm, then adrenomimetics (Salbutamol) are prescribed. Therapeutic tactics in the non-cardiogenic form of this pathology has its own characteristics. Additionally, glucocorticoids (Prednisone) are prescribed. In the case of the development of infectious complications (sepsis, pneumonia), the introduction of antibiotics is indicated.
Edema Prevention Measures
Pulmonary edema develops against the background of other diseases. To prevent him, you must follow the following rules:
- timely and correctly treat infectious diseases;
- no smoking;
- give up alcoholic beverages;
- Healthy food;
- do not use drugs;
- move more;
- eliminate stressful situations.
Many cardiovascular diseases are caused by an unhealthy lifestyle. The foundation for their development is high blood pressure.
In the presence of hypertension, you need to follow a diet and take medication for life. The most commonly prescribed drugs are from the group of ACE inhibitors.
Non-cardiogenic edema can be prevented by avoiding contact with harmful substances. The preventive measure is taking medications in the correct dosage.
The main reason for the development of edema is non-compliance with the doctor's recommendations for the treatment of the underlying disease. The use of folk remedies and ignoring the problem can lead to serious consequences.
The prognosis for pulmonary edema is determined by the following factors:
- underlying disease;
- the age of the person;
- completeness and timeliness of medical care.
Important to remember
If fluid appears in the lungs due to heart failure or pneumonia, an examination should be carried out immediately. The key to a favorable outcome of the disease is a quick reaction of others and timely competent treatment.
