Symptoms and sensations of pulmonary edema. Symptoms, causes and treatment of pulmonary edema
Pulmonary edema is a condition in which fluid accumulates in the lungs instead of air, which leads to a sharp disruption of gas exchange in the lungs and the development of hypoxia. Pulmonary edema is not an independent disease, but a disease that is a complication of other pathologies.
What causes pulmonary edema?
The causes of pulmonary edema can be of 2 types:
Cardiogenic pulmonary edema - occurs with pathological overload of the heart, as well as with acute heart failure.
Non-cardiogenic Pulmonary edema - occurs in the lungs during myocardial infarction, when blood stagnates in the vessels of the lung.
Non-cardiogenic causes of edema include respiratory diseases, such as pulmonary embolism and bronchial asthma. Complications after pneumonia in adults can also lead to pulmonary edema.
Other causes of pulmonary edema:
- Chest injuries;
- In newborns, pulmonary edema can result from severe hypoxia;
- Chemical poisoning;
- Drug use;
- Smoke inhalation;
- Uremia;
- Drowning;
- Cirrhosis.
Symptoms of pulmonary edema
Pulmonary edema mainly develops at night when a person is sleeping. A person wakes up and feels severe suffocation. After some time, the patient develops a convulsive cough. Signs of pulmonary edema are as follows: at first, sputum of normal consistency appears, but as the edema progresses, it becomes more liquid, and subsequently turns into plain water.
With slowly developing pulmonary edema, a person suffers from rapid breathing, which occurs for no obvious reason. Rapid breathing develops along with shortness of breath. First it occurs during physical activity, and then in a state of complete rest.
According to the flow there are:
Fulminant pulmonary edema - death occurs a few minutes after the onset of edema.
Acute pulmonary edema (lasting up to 1 hour) - appears after severe stress or too much physical activity
Prolonged pulmonary edema (duration 1-2 days) - develops with chronic inflammatory diseases of the lungs, chronic renal failure
Subacute - symptoms of edema develop gradually, sometimes increasing, sometimes subsiding - develops with acute liver or kidney failure, congenital heart defects.
The development of edema can be provoked by emotional stress, physical activity, or a person’s transition from a vertical to a horizontal position.
The first symptoms of incipient acute edema are: the appearance of pain in the chest, a feeling of squeezing. Then it becomes difficult to inhale and exhale, shortness of breath increases.
Patients with suspected pulmonary edema must be hospitalized.
What to do in case of pulmonary edema before the ambulance arrives?
- If a person is conscious, he needs to be moved to an upright or sitting position.
- Provide access to fresh air
- The patient needs to put a nitroglycerin tablet under the tongue; if the tablet has dissolved, but the condition has not improved, a second tablet should be given. You can take no more than 6 tablets per day.
- Unbutton the top buttons on your clothes
Treatment for this disease depends on its severity and the cause of its occurrence. It is aimed at normalizing pressure in the pulmonary circulation, reducing peripheral vascular resistance, and correcting acid-base balance disorders.
Edema that develops as a result of heart failure can be completely cured with the use of diuretics.
If the cause of pulmonary edema is an infection, antibiotics are used.
Particularly severe cases of pulmonary edema require the patient to be connected to a ventilator, which maintains his breathing at the proper level while specialists take measures to treat and eliminate the underlying cause of the disease.
Prevention of edema involves timely treatment of those diseases that can lead to it.
Pulmonary Edema
With pulmonary edema, fluid collects in the spaces outside the pulmonary blood vessels. In one type of edema, so-called cardiogenic pulmonary edema, fluid leakage is caused by an increase in pressure in the pulmonary veins and capillaries. As a complication of heart disease, pulmonary edema can become chronic, but there is also acute pulmonary edema, which develops quickly and can lead to the death of the patient in a short time.
What are the causes of pulmonary edema?
Pulmonary edema is usually caused by failure of the left ventricle, the main chamber of the heart, resulting from heart disease. In certain heart conditions, more pressure is required to fill the left ventricle to ensure sufficient blood flow to all parts of the body. Accordingly, the pressure in other chambers of the heart and in the pulmonary veins and capillaries increases. Gradually, some of the blood sweats into the spaces between the lung tissues. This prevents the expansion of the lungs and disrupts the gas exchange occurring in them.
In addition to heart disease, there are other factors that predispose to pulmonary edema:
Excessive amount of blood in the veins;
certain kidney diseases, extensive burns, diseased liver, nutritional deficiencies;
Impaired lymph outflow from the lungs, as is observed in Hodgkin's disease;
Reduced blood flow from the left upper chamber of the heart (for example, with narrowing of the mitral valve);
Disorders that cause blockage of the pulmonary veins.
What are the symptoms of pulmonary edema?
Symptoms in the early stages of pulmonary edema reflect poor expansion of the lungs and the formation of transudate. These include:
Sudden attacks of respiratory distress after several hours of sleep;
Difficulty breathing, which is relieved by sitting;
When examining the patient, there may be a rapid pulse, rapid breathing, abnormal listening sounds, distended jugular veins, and abnormal heart sounds.
With severe pulmonary edema, when the alveolar sacs and small airways fill with fluid, the patient's condition worsens. Breathing quickens, becomes difficult, and the cough produces foamy sputum with traces of blood. The pulse quickens, heart rhythms are disturbed, the skin becomes cold, clammy and acquires a bluish tint, sweating increases. As the heart pumps less and less blood, blood pressure drops, the pulse becomes thready.
How is the disease diagnosed?
Diagnosis is made based on symptoms and physical examination, followed by an arterial blood gas test, which usually shows decreased oxygen levels. In this case, disturbances in the acid-base balance and acid-base balance, as well as metabolic acidosis, may also be detected.
Chest x-rays usually reveal diffuse opacities in the lungs and often cardiac hypertrophy and excess fluid in the lungs.
In some cases, pulmonary artery catheterization is used for diagnostic purposes, which can confirm left ventricular failure and exclude adult respiratory distress syndrome, the symptoms of which are similar to those of pulmonary edema.
How is pulmonary edema treated?
Treatment is aimed at reducing the amount of fluid in the lungs, improving gas exchange and heart function, as well as treating the underlying disease.
As a rule, the patient is allowed to breathe mixtures with a high oxygen content. If an acceptable level of oxygen cannot be maintained, artificial ventilation is used to improve tissue oxygen supply and restore acid-base balance.
The patient may also be prescribed diuretics (eg, Lasix) to remove fluid in the urine, which in turn helps reduce the amount of extravascular fluid.
To treat cardiac dysfunction, in some cases digitalis glycosides and other arterial dilators (for example, niprid) are prescribed. Morphine can be used to relieve anxiety, ease breathing and improve blood circulation.
Causes of pulmonary edema: prevent the development of a terrible disease!
Acute pulmonary failure or pulmonary edema is a serious disruption of gas exchange in organs as a result of transudate entering the lung tissue from the capillaries. That is, the liquid enters the lungs. Pulmonary edema is a pathological condition accompanied by an acute deficiency of oxygen throughout the body.
Causes of pulmonary edema
Pulmonary edema is distinguished by causes and time of development
There are different forms of edema depending on the reasons for the development of the disease and the time of its development.
Types by speed of development
- Acute development. The disease manifests itself within 2-3 hours.
- Prolonged pulmonary edema. The disease lasts a long time, sometimes a day or more.
- Lightning current. It comes completely suddenly. The lethal outcome, as an inevitability, occurs within a few minutes.
There are a number of classic underlying causes of pulmonary edema.
Thus, non-cardiogenic edema is caused by various causes not related to cardiac activity. This could be liver disease. kidneys, toxin poisoning, injury.
Cardiogenic edema is caused by heart disease. Typically, this type of disease occurs against the background of myocardial infarction, arrhythmia, heart defects, and circulatory disorders.
Predisposing factors
- Sepsis. Toxins then enter the bloodstream.
- Pneumonia due to various types of infections or injuries.
- Exceeding doses of certain medications.
- Radiation damage to organs.
- Drug overdose.
- Any heart disease, especially during its exacerbation.
- Frequent attacks of hypertension.
- Pulmonary diseases, for example, bronchial asthma, emphysema.
- Thrombophlebitis and varicose veins, accompanied by thromboembolism.
- Low levels of protein in the blood, which manifests itself in cirrhosis of the liver or other pathologies of the liver and kidneys.
- A sharp change in air pressure when rising to a high altitude.
- Exacerbation of hemorrhagic pancreatitis.
- Entry of a foreign body into the respiratory tract.
All these factors together or one at a time can be a strong impetus for the occurrence of pulmonary edema. If these diseases or conditions occur, it is necessary to monitor the patient's health status. Monitor his breathing and general vital activity.
From the proposed video, find out how we harm our lungs.
Diagnostics
To take the necessary first resuscitation measures and to treat the patient, a correct diagnosis of the disease is required.
During a visual examination during an attack of suffocation and pulmonary edema, it is necessary to pay attention to the patient’s appearance and the position of his body.
During an attack, excitement and fear are clearly evident. And noisy breathing with wheezing and whistling can be clearly heard from a distance.
During the examination, pronounced tachycardia or bradycardia is observed, and the heart is hard to hear due to bubbling breathing.
In addition to a routine examination, an ECG and pulse oximetry are often performed. Based on these examination methods, the doctor makes a diagnosis.
In case of pulmonary edema, an electrocardiogram shows an abnormal heart rhythm. And with the method of determining blood oxygen saturation, a sharp decrease in oxygen levels is highlighted.
A chest x-ray is required. In difficult cases, clouding is observed in the image, which indicates that the alveoli of the lungs are filled with fluid.
To determine the main cause of the disease, it is necessary to know the clinical picture of the disease. In some cases, direct measurement of blood pressure in the vessels of the lungs is done. To do this, a special catheter is inserted into large veins of the chest or neck, which makes it possible to determine the causes and degree of development of pulmonary edema with 99% accuracy.
Additional diagnostic methods
- Biochemical blood test
- Ultrasound of the heart
- Coagulogram
- Echo KG
- Pulmonary artery catheterization
An experienced doctor, even a therapist, can make a diagnosis and determine the severity of the condition without a complex examination:
- Dry skin is not a serious condition
- Forehead with slight sweat – moderate severity
- Wet chest - serious condition
- Confusion and a completely wet body, including the chest and abdomen, is an extremely serious condition
If controversial issues arise, consultations are held with a pulmonologist and a cardiologist, a consultation is created and a comprehensive decision is made on the treatment of the disease, as well as measures to prevent asphyxia.
Pulmonary edema: symptoms
Usually the disease develops suddenly, at night, often during sleep. If the attack is lightning fast and does not develop in a hospital setting, then it is impossible to save the patient without emergency ambulance, since the transudate, rich in protein, forms a whipped dense foam during the attack, which leads to a decrease in respiratory activity and oxygen starvation.
But such a development of the disease is rare. More often, pulmonary edema develops gradually, sometimes with preceding signs.
Symptoms
Such symptoms may appear a couple of minutes before swelling or several hours before.
An attack can be triggered by external factors
An attack can be triggered by stress, hypothermia, psycho-emotional stress, a sharp fall, or physical exertion.
At the beginning of the attack, the resulting suffocation and cough forces the patient to sit down or lie down. In this case, blueness of the lips, nails, and eyelids appears.
Nervous fever occurs. and the skin takes on a gray tint. And cold sweat appears on the surface. A sign of mental agitation and motor restlessness appears.
Each time an attack is accompanied by an increase in blood pressure and tachycardia. During an attack, additional muscles are involved in breathing. Breathing increases up to 30 times per minute. Shortness of breath increases, making it difficult to speak.
The patient's breathing becomes increased, stridorous, whistling, without wheezing. Veins swell in the neck. The face takes on a puffy appearance. When you cough, pink foam is produced. And the pulse increases sharply during coughing, reaching 160 beats per minute.
In severe cases, confusion and coma are possible. The pulse becomes threadlike, and breathing is periodic, rare and shallow. With the development of asphyxia, death occurs.
If such symptoms occur, you should immediately seek emergency help by calling an ambulance. Only timely medical measures will help the patient avoid asphyxia and death. In such cases, you cannot hesitate.
Consequences
The consequences of pulmonary edema can be different. If assistance is provided in a timely and qualified manner, then no serious complications are expected.
After pulmonary edema, a person may experience symptoms of pneumonia
It is possible that for some period there will be signs of congestive pneumonia, pneumofibrosis, and heart pain. There is a possibility of developing chronic respiratory diseases.
However, often, despite timely modern methods of treatment and diagnosis, in 50% of cases, pulmonary edema combined with associated myocardial infarction leads to death.
In other cases of prolonged hypoxia, some irreversible processes occur in the nervous system and brain structure.
If there is damage to the central nervous system in the form of autonomic disorders, then there is no cause for special concern. In cases of brain destructuration, irreversible processes leading to the death of the patient are possible.
The sooner the attack of pulmonary failure is stopped, the better the prognosis for the patient. To avoid serious consequences, it is necessary to follow the doctor’s recommendations, adhere to diets, prevent contact with allergens, and give up bad habits, especially smoking.
Pulmonary edema: treatment
Treatment of a patient with pulmonary edema is carried out in a hospital setting in the intensive care unit. Treatment largely depends on the condition of the patient and his individual characteristics of the body.
Principles of treatment
- Decreased respiratory excitability
- Increased contractions of the heart muscle
- Unloading blood circulation in a small circle
- Saturation of blood with oxygen - oxygen therapy - inhalation from a mixture of oxygen and alcohol
- Calming the nervous system using sedatives
- Eliminating fluid from the lungs using diuretics
- Treatment of the underlying disease
- Use of antibiotics in case of secondary infection
- The use of drugs that improve heart function
A wide range of drugs are used in the treatment of pulmonary edema
In hospital treatment, the following drugs are used:
- Narcotic analgesics and neuroleptics, for example, Morphine, Fentanyl in small doses, intravenously.
- Diuretics, for example, Lasix, Furosemide.
- Cardiotonic glycosides, for example, Strophanthin, Korglykon.
- Bronchial antispasmodics: Euphylline, Aminophylline.
- Hormonal drugs - glucocorticoids, for example Prednisolone intravenously.
- Broad-spectrum antibiotics. The most popular uses are Ciprofloxatin and Imipenem.
- When the level of protein in the blood is low, plasma from donor blood is used as an infusion.
- If the swelling is caused by thromboembolism, intravenous Heparin must be used.
- To lower blood pressure, use Dobutamine or Dopamine.
- For low heart rate, Atropine is used.
All doses and quantities of drugs for different purposes are prescribed to the patient individually. It all depends on the age of the patient and the specifics of the disease, on the state of the patient’s immunity. These medications should not be used before a medical prescription, as this will worsen the situation.
After the attack has been relieved and breathing functions have been restored, it is possible to use folk remedies. Their use can be started after consultation with a doctor unless prohibited.
An effective method in this treatment is the use of decoctions, infusions and teas that have an expectorant effect. This is what will help remove serous fluid from the body.
During treatment, it is imperative to direct actions to improve not only the physical and physiological condition of the patient. It is necessary to bring a person out of a stressful state by improving his emotional state.
Any treatment during pulmonary edema should be carried out under the strict supervision of the attending physician. During the first period of therapy, all drugs are administered intravenously, since it is very difficult to take drugs orally.
Providing emergency assistance
There are a number of urgent measures to provide first aid to a person with pulmonary edema. The absence of such assistance can worsen the patient's condition.
First aid:
- It is necessary to give the patient a sitting position, and it is necessary to lower his legs to the floor.
- Organize direct access to fresh air, which will help breathing.
- Place your feet in hot water; foot baths will dilate blood vessels.
- Allow the patient to breathe freely by removing tight and constricting clothing.
- Monitor breathing and pulse, measure blood pressure every 5 minutes.
- Allow the patient to inhale alcohol vapor.
- It is imperative to restore the patient’s mental and emotional state.
- For low blood pressure, give nitroglycerin.
- Apply venous tourniquets to the lower extremities.
- Provide access to a large vein upon the arrival of doctors.
First aid is required before the ambulance arrives
These measures are carried out before the ambulance arrives. The emergency team, prior to medical examination and diagnosis, takes some measures before arriving at the hospital. Usually this is:
- Suctioning foam and inhaling alcohol vapor
- Removing excess liquid
- Pain relief for pain or shock
- Subcutaneous administration of camphor solution
- Using an oxygen cushion to enrich breathing with oxygen
- Bloodletting
- Pressure regulation
The remaining measures are carried out in the hospital under the guidance of specialists.
After complete stabilization of the patient’s condition, treatment of the patient begins, which is aimed at eliminating the causes of edema.
Preventing oxygen starvation is the primary task of doctors. Otherwise, the consequences of the attack will be irreversible.
The coordinated work of emergency workers and the correct actions of loved ones will help avoid serious complications and consequences after an attack of respiratory failure.
Pulmonary edema: prognosis
The prognosis after pulmonary edema is not always favorable
It must be understood that the prognosis after suffering pulmonary edema is rarely favorable. Survival rate, as already mentioned, is no more than 50%.
However, many people experience some deviations after treatment. If pulmonary edema occurs against the background of myocardial infarction, then the mortality rate exceeds 90%.
In case of survival, it is necessary to be observed by doctors for more than a year. It is imperative to apply effective therapy to cure the underlying disease that caused pulmonary edema.
If the root cause is not eliminated, then there is a 100% chance of relapse.
Any therapy is aimed at relieving swelling and preventing its recurrence.
Only correct and timely treatment measures can give a favorable prognosis. Early pathogenetic therapy at the initial stage, timely detection of the underlying disease, and proper treatment will help give a favorable prognosis for the outcome of the disease.
Prevention of pulmonary edema
Preventive measures in the fight against pulmonary edema are timely treatment of diseases that cause edema. Eliminating the causes is prevention.
A healthy lifestyle, compliance with safety rules when working with harmful substances, poisons and toxins, compliance with the dosage of medications, no alcohol abuse. drugs and overeating are all preventive measures that will help avoid attacks of pulmonary failure.
If you have chronic diseases or hypertension, you should follow all doctor’s instructions in good faith.
An additional preventive measure is maintaining a healthy lifestyle. proper nutrition and an active lifestyle.
It is impossible to reliably exclude the moment of an attack, since it is impossible to provide guaranteed insurance against infection or injury, but you can reduce the risk of its occurrence. It should be remembered that timely assistance for pulmonary edema is a saved life.6
Pulmonary edema, a life-threatening pathology, requires treatment and urgent hospitalization of the patient. This condition is characterized by overflow of the pulmonary capillaries, transudation (leakage) of fluid from the vessels into the alveoli and bronchi.
It happens that pulmonary edema appears at night, when a person is sleeping (as a complication of the underlying disease) and during severe physical exertion.
A physical examination, including listening to the chest with a stethoscope, is a necessary first step. Abnormal lung sounds consistent with pulmonary edema are usually observed, although they may sometimes be obscured by the loudness of the heart murmur or other abnormal heart sound. If a cardiogenic cause is suspected, it is important to pay attention to heart sounds, although they may not always be present.
Video: pulmonary edema - when it occurs, diagnosis, clinic
To confirm and definitively diagnose pulmonary edema, a chest x-ray is usually performed. This will identify any areas of fluid accumulation in the lungs. Abnormalities in the heart that may be related to underlying causes of pulmonary edema may or may not be visible on a chest x-ray. For this reason, it is recommended that an echocardiogram be used in pets suspected of suffering from a cardiogenic cause.
Classification
Pulmonary edema as a complication occurs when there is a disruption in the regulation of the amount of fluid entering and leaving the lungs. Simply put, with this complication, the lymphatic vessels do not have time to remove excess blood filtered from the capillaries. And due to high blood pressure and low protein levels, fluid moves from the pulmonary capillaries to the alveoli of the lungs. That is, the lungs fill with fluid and cease to perform their functions. The causes of pulmonary edema are divided into two groups, with the main one in first place – heart disease:
Any breed of dog or cat is equally susceptible to the effects of pulmonary edema. However, cats and dogs of breeds predisposed to specific, inherited heart diseases are undoubtedly at higher risk. Treatment for pets with pulmonary edema largely depends on the cause, as treatment of all underlying conditions is the primary treatment in all cases. However, there is a comprehensive approach to treatment that includes a three-pronged strategy.
Stabilizing Patients: Most patients with pulmonary artery disease are in trouble. They are usually treated with oxygen therapy and medications to help them relax so they can properly oxygenate their tissues. Resolution of swelling: Treatment with diuretics and other drugs may help remove fluid from the lungs. Treat the root cause: This three-pronged approach always culminates in treating the underlying disease. Without this step there can be no expectation of long-term survival. . When the cause of pulmonary edema cannot be isolated or when it is considered incurable, there are still some well-established methods that help control the accumulation of fluid in the lung tissue.
- Hydrostatic edema– occurs due to diseases in which intravascular hydrostatic pressure increases and fluid leaks from the vessel into the interstitial space, and then into the alveolus. The main cause of this edema is cardiovascular disease.
- Membranous edema– occurs under the influence of toxins, when the walls of the capillary or alveoli are damaged and the fluid escapes into the extravascular space.
There are two types of this complication: interstitial and alveolar. These, in fact, are stages of the whole process, since the fluid overcomes two barriers (histohematic and histoalveolar). Comparative characteristics of both processes:
Diuretics are the mainstay of treatment in these cases, as well as other drugs that help control other problems associated with the underlying disease. For example, most heart diseases in pets are considered manageable but not curable. These chronic conditions may require long-term diuretic therapy along with any additional medications to control the heart disease itself.
Symptoms of complications of pulmonary edema
Veterinary costs for pulmonary edema vary depending on the cost of treating the underlying condition. In general, however, treating an acute event is less expensive than long-term treatment for heart disease, which can cost hundreds of dollars a month in medications alone.
| Interstitial | Alveolar | |
| Symptoms of pulmonary edema | Shortness of breath, cough, no sputum | Cough, foamy sputum, wheezing (dry and then wet) heard |
| Liquid barrier | Histohematic (on the blood-tissue path) | Histoalveolar (on the tissue-alveolus path) |
| Characteristic | The fluid passes into the interstitial space from the vessel, only the lung parenchyma swells | Blood plasma, overcoming the wall of the alveoli, sweats into its cavity |
| without providing medical help with progression | Transitions into alveolar | Suffocation, death |
Another classification is based on the severity of manifestations.
Causes and development
Cardiogenic – develops in acute left heart failure
Scheme of development of cardiogenic pulmonary edema
The cause of AHF (acute heart failure) may be:
Because many of its underlying causes are either inherited or traumatic, pulmonary edema is not generally considered preventable. However, many patients with underlying heart conditions can be successfully managed to ensure their conditions never progress to pulmonary edema.
Emergency management of dogs and cats with congestive heart failure. Association between hydration assessment and body weight change after fluid therapy in critically ill dogs and cats. Management of heart failure: principles of treatment, therapeutic strategies and pharmacology. Textbook on canine and feline cardiology.
- pathology of the atrium - mitral stenosis
- and the ventricle - myocardial infarction, hypertension, heart defects, as a result of which the contractile functions of the heart muscles are reduced.
With decompensated heart disease, with stagnation in the pulmonary circulation (which also happens with bronchial asthma, emphysema), in case of increased pressure in the capillaries and untimely provision of medical care, pulmonary edema may develop.
Pulmonary edema, defined as excessive extravascular fluid in the lungs, is a common and serious clinical problem. Pulmonary edema can be life-threatening, but effective therapy is available to save patients from the harmful effects of pulmonary imbalance, which can usually be identified and, in many cases, corrected. Because rational and effective therapy depends on understanding the basic principles of normal and abnormal fluid, solute, and protein transport in the lungs, this chapter begins with a brief review of the basic factors that regulate fluid and protein filtration in healthy lungs before focusing on the pathophysiology of pulmonary edema.
In children, cases of cardiogenic pulmonary edema are extremely rare. Their main causes are others: poisoning with harmful substances (for example, turpentine or kerosene fumes), shock, inflammatory reactions, drowning.
Not cardiogenic
- Arose as a result of other reasons:
- aspiration - entry of foreign matter into the lungs
- traumatic - chest injuries
- shock - in all three cases the pathology is associated with membrane damage
- cancerous - the lymphatic system of the lungs is disrupted, that is, the outflow of fluid is hampered
- neurogenic - here the causes of pulmonary edema lie in central mechanisms; with intracranial hemorrhage, with severe convulsions or due to brain surgery, fluid accumulation in the lungs is possible.
- With a sharp ascent to high altitudes (3 km), high-altitude pulmonary edema may occur.
- ARDS - acute respiratory distress syndrome occurs due to injury, severe infectious disease, inhalation of toxins, or pulmonary infections, which disrupts the integrity of the alveoli and increases the risk of fluid leaking into them from the vessels.
- With a sharp process of expansion of the lungs, for example with pneumothorax, with exudative pleurisy - in this case, swelling usually occurs on one side of the lung - one-sided.
- Rare causes include pulmonary embolism, when a blood clot enters the vessels of the lung and clogs them.
Scientists have found that athletes who expose themselves to enormous physical activity have a certain risk of developing pulmonary edema. These are marathon athletes, freedivers, scuba divers, long-distance swimmers, and climbers who climb to great heights. Moreover, some of them experienced mild swelling after receiving the load, and this fact was detected more often in women than in men.
The rest of the chapter discusses the diagnosis, treatment, and resolution of pulmonary edema. Chapters 6 and 9 also provide additional information on the regulation of fluid balance in the lungs, and Chapter 100 provides details on the onset and treatment of acute lung injury and acute respiratory distress syndrome, which are now defined and subsequently discussed.
Pulmonary edema can be detected in adults on a chest x-ray when extravascular pulmonary fluid increases by approximately 35%. Although most radiographic signs of pulmonary edema are nonspecific, improved radiographic techniques coupled with an improved understanding of the pathophysiology of pulmonary edema are increasing the utility of the chest radiograph in the diagnosis of pulmonary edema.
Symptoms
A person subjectively feels the following symptoms of pulmonary edema.
| In the initial stage (interstitial edema) | As alveolar edema progresses, the existing sensations are added to |
|
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Attention! When initial symptoms of pulmonary edema appear, it is important to seek qualified medical attention as soon as possible. help, so you should urgently call an ambulance.
Kerley's lines are interlobular sheets of abnormally thickened or dilated connective tissue that touch the X-ray beam. These are more accurately called septal lines. Condensed septal lines can arise from a variety of processes, including fibrosis, pigment deposition, and pulmonary hemosiderosis. However, when they are temporary, these lines are usually caused by swelling. These septal lines of edema are more clearly visible in older children and adults with chronic edema than in infants, presumably because they are wider.
Basic diagnostic methods
| History taking | During the interview, the doctor finds out the factors that contributed to pulmonary edema to choose the right treatment tactics. Heart diseases provoke cardiogenic edema, others mentioned above are not cardiogenic. |
| External examination, during which the doctor reveals: |
|
| Auscultation (listening): |
|
| Percussion | a boxy tone of the sound, dullness over the posterior lower parts of the lungs, and an increase in the borders of the liver are determined. |
| Palpation | a weak, frequent pulse is detected, the filling of the neck veins is detected, and the degree of moisture of the skin is determined. |
An experienced doctor can easily determine the severity of a patient’s condition by the moisture of the skin:
Perivascular and peribronchial cuffing are also radiographic signs of interstitial edematous fluid. For hydrostatic reasons, perivascular edema is greatest in gravity-dependent areas, so the normal bridging action of the lung is less in this region. Increased resistance in the vessels of the lower lobe contributes to the redistribution of blood to the upper lobes. This sign is, of course, of limited value in infants because they are more likely to be in a supine position, have smaller gravity-induced differences due to their size, and usually have only a slight increase in pulmonary arterial pressure compared to children and adults.
- not severe – dry skin
- moderate severity – forehead with perspiration
- heavy - wet chest
- extremely severe – wet chest and stomach
Additional diagnostic methods
- X-ray examination:
- interstitial edema – blurred pulmonary pattern, decreased transparency of the perihilar regions
- alveolar edema – changes in the hilar and basal regions in the form of a focal, diffuse (widespread) form or “butterfly wings”.
- Electrocardiography - reveals signs of heart disease, as well as overload of its left side.
- Echo CG - performed for non-acute pulmonary edema to determine the concomitant disease that provoked this complication.
- Measurement of pulmonary capillary wedge pressure (hydrostatic pressure) using a catheter inserted into the pulmonary artery. This indicator is needed to make a correct diagnosis, since PCWP increases with cardiogenic edema, and remains the same with non-cardiogenic edema.
- A biochemical blood test (transaminases) also allows you to distinguish cardiogenic edema (transaminases are elevated) from non-cardiogenic edema (normal values).
Differential diagnosis
It is important to distinguish pulmonary edema from bronchial asthma in time.
What can be the consequences of pulmonary edema?
More severe forms of pulmonary edema usually cause percigaric haze, presumably because large perivascular and peribronchial fluid collections are present at this location. A reticular or lattice pattern may also be present, which is more common in an upright person. Once the magnitude of pulmonary edema is severe enough to result in permanent airway closure or alveolar flooding, it is very difficult to separate edema, atelectasis, and inflammation on chest radiographs.
| Pulmonary edema | Bronchial asthma | |
| Anamnesis | Most often cardiac | Allergic |
| Dyspnea | Inspiratory (difficulty breathing) | Expiratory (difficulty exhaling) |
| Breath | Bubbling, wheezing, orthopnea | Wheezing involving auxiliary muscles |
| Sputum | Foamy with a pinkish tint | Viscous, difficult to separate |
| Percussion | Boxy sound, dullness over some areas | Boxed sound |
| Auscultation | Hard breathing, moist, coarse rales | Exhalation is prolonged, vesicular breathing with an abundance of whistling, buzzing dry rales |
| ECG | Overload of the left departments | Changes in the right side of the heart |
First aid for swelling
Before the doctor arrives, you can do the following on your own:
- Place the patient in a sitting or half-sitting position with legs down
- Provide reliable access to a large peripheral vein (for subsequent catheterization)
- Organize access to fresh air
- Allow the patient to inhale alcohol vapors (96% for adults, 30% for children)
- Take a hot foot bath
- Use venous tourniquets on the limb (from 30 minutes to 1 hour)
- Constantly monitor your breathing and pulse
- In the presence of nitroglycerin and not low blood pressure - 1-2 tablets under the tongue.
Emergency care for pulmonary edema, provided by the ambulance team before arriving at the hospital, is as follows:
Air bronchograms indicate airless distal lung units rather than the underlying cause. Because pulmonary edema can lead to airway obstruction in children from both the vagal reflex 27 and bronchial foam, 32 airway closure may occur and cause air trapping. 29 Thus, low diaphragms may be a useful sign of interstitial edema, provided there are no other causes of airway obstruction. The progressive recruitment of connective tissue spaces with the help of edematous fluid in both cardiac and renal disease leads to vaginal erosion, peribronchial cuffing and a cloudy picture of increased lung density.
- Oxygen therapy (active oxygen saturation)
- Foam suction and anti-foam therapy (oxygen inhalation through ethyl alcohol solution)
- Diuretic therapy (Lasix, Novurit) – removes excess fluid from the body; for low blood pressure, reduced doses of drugs are used
- If there is pain, take painkillers (analgin, promedol)
- Other drugs depending on blood pressure level:
- high – ganglion blockers (promote blood outflow from the heart and lungs and flow to the extremities: benzohexonium, pentamine), vasodilators (dilate blood vessels: nitroglycerin)
- normal – reduced doses of vasodilators
- low – inotropic agents (increase myocardial contractility: dobutamine, dopmin).
Treatment of pulmonary edema
In a hospital setting, therapy is continued.
Treatment of pulmonary edema
Pulmonary edema is characterized by the accumulation of fluid in the air spaces and interstitium of the lungs. This may be due to internal pathology of the lung or due to systemic factors. Consequently, pulmonary edema has traditionally been classified into cardiogenic and noncardiogenic causes. Cardiogenic pulmonary edema occurs due to acute left ventricular failure after a series of insults, such as myocardial infarction. Noncardiogenic pulmonary edema may be caused by acute lung injury or respiratory distress syndrome in adults.
- Oxygen therapy - inhalation of oxygen with ethyl alcohol to extinguish foam in the lungs
- Narcotic analgesics (painkillers) and antipsychotics (drugs to reduce psychomotor agitation): reduce hydrostatic pressure in the pulmonary vessels and reduce venous blood flow. Drugs: morphine, fentanyl
- Diuretics - reduce the volume of circulating blood, cause dehydration of the lungs: furosemide
- Cardiac glycosides (provide a cardiotonic effect): strophanthin, corglycone
- Other drugs for the treatment of pulmonary edema depending on the blood pressure level (see above)
- Relief and prevention of bronchospasm: aminophylline, aminophylline
- Glucocorticosteroids, surfactant therapy: used for non-cardiogenic pulmonary edema.
- For infectious diseases (pneumonia, sepsis) - broad-spectrum antibiotics.
Important to know: cardiac glycosides are mainly prescribed to patients with moderate congestive heart failure; Glucocorticosteroids are contraindicated for cardiogenic pulmonary edema.
Cardiogenic pulmonary edema is caused by increased pulmonary hydrostatic pressure secondary to increased pulmonary venous pressure. Acute pulmonary edema is often the result of many beliefs about coronary artery disease and its complications. The patient may have a massive myocardial infarction and subsequently develop papillary muscle dysfunction or a ventricular septal defect, which may help reduce left ventricular dysfunction and pulmonary edema. In addition, a patient with preexisting left ventricular dysfunction may have worsening left ventricular function with myocardial ischemia or infarction with resultant acute pulmonary edema.
Prevention
For chronic heart failure, ACE inhibitors (medicines for the treatment of hypertension) are prescribed. For recurrent pulmonary edema, isolated blood ultrafiltration is used.
Prevention also involves avoiding factors that provoke pulmonary edema: timely treatment of heart disease, lack of contact with toxic substances, adequate (not increased) physical and respiratory stress.
Although coronary artery disease is probably the most common etiology of acute cardiac decompensation with resultant pulmonary edema, other etiologies include aortic stenosis and diastolic dysfunction in hypertensive crisis. Pulmonary edema can be found at any age. However, the most common cause of pulmonary edema is cardiogenic. Cardiogenic pulmonary edema is caused by increased hydrostatic pressure in the pulmonary capillary, which leads to fluid transudation into the interstitium and alveoli.
Is pulmonary edema treated with folk remedies?
Both left atrial deviation and left ventricular dysfunction can lead to cardiogenic pulmonary edema. On the other hand, pulmonary edema leakage is a consequence of capillary endothelial cell injury. Intravascular hydrostatic pressures are normal, but the endothelial cells lose their integrity and no longer provide a semipermeable membrane. Most of these patients suffer from acute respiratory distress syndrome.
It can have various causes and consequences; it is a pathology that can result from diseases of the heart, liver and kidneys. What processes occur in the body during swelling? Briefly they can be described as follows:
Mechanisms of development and causes of the syndrome
The pathogenesis of pulmonary edema depends on the disease that caused it. There are 3 mechanisms by which swelling can develop:
Symptoms
As a rule, symptoms of the disease appear when a person is in a supine position. How to determine that pulmonary edema is beginning? Typically these are the following signs:
Factors causing the development of edema
The causes of pulmonary edema are quite varied. Swelling can occur due to:
Pulmonary edema can be affected by the progression of diseases such as:
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Development of edema in infants
What causes edema in young children who have not yet had provoking diseases? Pulmonary edema in infants has a special pathogenesis. The cause of the development of the syndrome in newborns can be:
Types of swelling depending on the cause
All pulmonary edema can be divided into groups depending on the cause of their development. There are 2 types of edema:
- cardiogenic (heart). During it, left ventricular failure develops, and blood stagnation occurs in the lungs. To determine that edema is due to heart disease, it is necessary to measure the capillary pressure of the lungs. It should exceed 30 mmHg.
Since cardiogenic edema occurs very quickly, it often causes sudden death in a person.
- non-cardiogenic. It happens less often. There are 8 subspecies (Table 1).
Table 1 - Types of non-cardiogenic edema and their causes
| Subspecies name | Causes and manifestations |
|---|---|
| Shock | Stagnation forms in the blood vessels connecting the heart and lungs. This occurs due to deterioration of the left ventricle due to a state of shock. As a result, intravascular hydrostatic pressure increases, and part of the edematous fluid flows from the vessels into the lung tissue |
| Cancerous | Develops in people who have a malignant tumor in the lungs. With this disease, the lymph nodes do not perform their functions (do not remove excess fluid from the lungs) properly. Because of this, blockage of the lymph nodes occurs. As a result, transudate begins to accumulate in the alveoli |
| High-rise | It develops during ascent to higher elevations. This edema is characterized by high pressure in the blood vessels, as well as capillary permeability, which occurs due to oxygen starvation. This type of swelling occurs extremely rarely. |
| Toxic | First, an adult begins to cough, he feels short of breath, and watery eyes occur. All this occurs due to the fact that poisonous gases or vapors enter the lower respiratory tract. This subtype of edema is very difficult and can be fatal. This is due to the fact that due to inhalation of toxic fumes, the medulla oblongata begins to work worse and subsequently the heart or breathing may stop. |
| Traumatic | Develops due to defects in the membrane covering the lung. Typically, this swelling develops against the background of a disease such as pneumothorax. During it, the capillaries located next to the alveoli are damaged. As a result, red blood cells, as well as the liquid part of the blood, enter the alveoli |
| Allergic | It develops in people who are hypersensitive to any allergens. So, it can occur due to a wasp or bee sting. In addition, pulmonary edema can also occur during blood transfusion. With such swelling, the allergen must be removed from the human body immediately. Otherwise, anaphylactic shock may occur, which will certainly cause death. |
| Neurogenic | During it, spasms occur in the veins. Due to disruption of the innervation of the vessels of the respiratory organs, hydrostatic pressure in the intravascular space increases. Then the plasma begins to flow out of the bloodstream. First it enters the interstitium, and then into the alveoli |
| Aspiration | If the contents of the stomach enter the bronchi, airway obstruction will occur. It will also lead to increased permeability of the smallest blood vessels. From them, plasma will begin to flow into the pulmonary alveoli |
Possible risks of developing edema
Pulmonary edema in adults and children requires emergency medical intervention. If help is not provided to the patient on time, pulmonary edema can cause many negative consequences that threaten the patient’s life.
The development of the syndrome can lead to:
Swelling of the lungs can also cause:
- ischemic damage to various organs and body systems;
- development of bronchitis or pneumonia;
- cerebral circulatory disorders;
- segmental atelectasis;
- heart failure;
- pneumofibrosis;
- cardiosclerosis.
How pulmonary edema will proceed and whether there will be negative consequences for a person’s health and life depends on the reasons that cause it. However, it is possible to cope with this pathology, but only with timely help from specialists.
The respiratory function of bedridden patients is at risk, in particular due to the fact that the person is always in a supine position, which reduces the circulation of fluids in the body, causing. A weakened body, susceptibility to infectious diseases and stagnation in the pulmonary circulation can lead to serious consequences. In patients with unstable hemodynamics, pulmonary edema is one of the most common complications, and the sooner a person receives the necessary help, the less the body will suffer from such a pathological process.
Classification of the disease
The human pulmonary system is a complex and precise mechanism, consisting of several systems that completely complement and compensate for each other’s work. Adequate gas exchange in the lungs occurs with the participation of the alveoli and the smallest capillaries. Violation of the permeability of capillary walls, stagnation in the pulmonary circulation, constant lying position in a person and edema (positive hydrobalance of the body) become factors leading to such a complication.
Pulmonary edema is classified according to the mechanism of development:
- Hydrostatic edema. It is formed when pressure in the pulmonary circulation increases. Under the influence of increasing pressure, edema develops, pressing on the walls of the capillaries, due to which excess fluid gradually seeps into the alveoli. Most often, hydrostatic edema is caused by heart disease, and in particular heart failure.
- Membranous edema. Against the background of an infectious process, there is a large amount of toxins secreted by microorganisms in the blood. Such toxic substances have a strong destructive effect on the walls of small vessels and capillaries, which leads to leakage of fluid into the alveoli. The more intense the infectious process, the greater the likelihood that pulmonary edema will soon occur in bedridden patients.
One of the triggering factors for the formation of edema is the very fact that a person is weakened and is in a supine position. This leads to shallow breathing, in which not all lobes of the lungs participate. Weakened breathing contributes to the development of edema of the alveoli, which are not involved in the act of breathing. Moreover, any processes such as pneumonia, heart disease or infectious diseases can give a powerful impetus to the development of edema in bedridden patients.
Symptoms of the disease
Pulmonary edema in bedridden patients often develops gradually; even over several days, fluid gradually accumulates and makes it difficult for a person to breathe. But there are different situations depending on the root cause of the formation of edema. There are 3 stages of disease development. They differ in the rate at which swelling and symptoms increase. The faster the swelling develops, the brighter and clearer the patient’s symptomatic picture will be visible.
| Stage 1:lightning fast | Stage 2:acute | Stage 3:protracted |
| The increase in edema occurs so rapidly that, as a rule, it comes as a complete surprise and shock to the patient. This stage has the most negative effect on the body, because capillaries are traumatized, which increases the rate of growth of fluid and blood into the alveoli | The swelling occurs within 3-4 hours. Symptoms increase gradually and often do not immediately begin to bother the patient | This stage is the most invisible. The swelling grows so slowly that a person simply does not notice it. Also, stage 3 is the easiest to respond to drug therapy. |
Symptoms of pulmonary edema in bedridden patients are not very diverse, therefore, for example, the protracted stage is the most difficult to detect. Since the main system affected is the lungs, the symptomatic picture is expressed by insufficient respiratory function, but changes are also present in other body systems, namely:
- Increasing wheezing in the lungs. It develops when fluid in the lungs of a bedridden patient accumulates in such quantities that wheezing will be heard at a distance from the person with each inhalation and exhalation. The stronger the swelling, the more wheezing the patient will hear.
- Difficulty breathing. A person experiences a feeling of lack of air due to a decrease in the lung tissue involved in the act of breathing.
- Bloody, foaming sputum. With each inhalation, there is an increase in the release of blood through the smallest capillaries into the alveoli. Mixing with liquid, it forms bloody, foamy sputum, which is one of the most striking and reliable symptoms of edema.
- Blueness of the skin. Since not all lung tissue participates in breathing due to edema, the supply of oxygen to the body decreases sharply. This causes hypoxia and, as a result, cyanosis (cyanosis). The stronger and longer the hypoxia, the stronger the effect on the brain, whose metabolic processes are impossible with a low level of oxygen in the blood.
- Fall in blood pressure. With a small loss of blood there will be no significant damage to blood pressure, but if the volumes are significant, then the numbers on the tonometer can drop to 80-90 mmHg.
- General weakness and fatigue. Pulmonary edema in bedridden patients greatly debilitates the body, as there is a breakdown in the most important system - breathing. Coupled with low blood pressure, a person feels severe weakness and drowsiness.
The symptomatic picture of pulmonary edema depends on the rate of fluid growth. But since the body of a bedridden patient is already subject to serious stress and changes, there are often one or two symptoms, no more. Therefore, it is important to understand how pulmonary edema occurs in bedridden patients and to know what needs to be done in such situations.
First aid and treatment of pulmonary edema
Video
Pulmonary edema is a rather serious condition in which transudate leaves the capillaries and enters the tissues of the lung and alveoli. This process leads to decreased function of the alveoli, as well as disruption of normal gas exchange and oxygen starvation. Against this background, the composition of the blood changes significantly, and the concentration of carbon dioxide in it increases. This pathological process is accompanied by severe depression of the central nervous system. The accumulation of excess interstitial fluid leads to edema. Pulmonary edema is often the cause of death in people of all ages. The prognosis depends on the speed of providing first aid to the patient.
General description of the pathology
The development of the primary mechanism of edema is very complex. The interstitium consists of lymphatic vessels, connective tissue, blood vessels and intercellular fluid. The entire complex is exposed by a special visceral pleura. The extensive branching of hollow tubes makes up the lungs. The entire respiratory system is immersed in the interstitium. This substance is formed by plasma that comes out of blood vessels. After this, the plasma is absorbed again into the lymphatic vessels, which are connected to the vena cava. Thanks to this complex process, the liquid supplies oxygen and necessary nutritional components to the cells and removes metabolic products from them.
If the volume of intercellular fluid or its outflow is impaired, then pulmonary edema develops in the following cases:
- If a significant increase in hydrostatic pressure in the vessels leads to an increase in intercellular fluid. In this case, doctors talk about hydrostatic edema.
- If the increase in fluid is due to excessive filtration of plasma. In this case, they talk about membranous edema.
Pulmonary edema is a life-threatening condition that requires emergency medical attention. This pathology occurs more easily against the background of chronic diseases and most often occurs at night. This form of the disease responds well to medication.
Pulmonary edema in heart disease develops rapidly, the patient’s condition deteriorates very quickly and there is very little time to provide first aid.
In the fulminant form of cardiogenic edema, it is often impossible to save the patient.
Reasons
There are many reasons for the occurrence of pathology. Pulmonary edema cannot be considered an isolated disease. This is just a complication of some pathological process in the body. The cause of acute pulmonary edema can be:
- Diseases that are accompanied by the release of various toxins into the blood. This is observed with sepsis and pneumonia, as well as with an overdose of certain medications and drugs, such as heroin and cocaine. Radiation damage to the lung tissue also leads to edema. Toxins greatly disrupt the structure of the membrane, due to this its permeability increases significantly, and liquid from small capillaries flows beyond the boundaries of the vessels.
- Heart pathologies in the stage of decompensation, which are accompanied by failure of the left ventricle of the heart and significant congestion in the pulmonary circulation. This is typical for heart attack and severe heart defects.
- Lung diseases that lead to congestion in the right circulation. Such pathologies include bronchial asthma and emphysema.
- Thromboembolism of the pulmonary artery. This phenomenon occurs when there is a tendency to develop blood clots. The risk group includes patients with hypertension and varicose veins. In such patients, a blood clot may form, which then breaks off from the vascular wall and migrates throughout the body with the bloodstream. Once a thrombus enters the pulmonary artery, it clogs it. This leads to a strong increase in pressure in the vessel and the capillaries extending from it. Fluid pressure increases in these vessels, which ultimately leads to the accumulation of excess fluid in the lungs.
- Pathologies that are accompanied by a decrease in protein levels in the blood. This includes severe liver and kidney diseases. In patients with liver cirrhosis or nephritis, oncotic pressure in the blood decreases, which leads to pulmonary edema.
- A large volume of fluid that is infused intravenously can also cause pulmonary edema. This occurs if forced diuresis is not performed simultaneously with the infusion. Due to this, the hydrostatic pressure of the blood increases, which leads to a serious condition.
In adults, pulmonary edema is diagnosed much more often than in children.. Moreover, in an elderly person the risk of developing such a pathology is much higher than in young people.
Athletes who train hard have a high risk of developing pulmonary edema. Some athletes experience mild swelling after hard training; female athletes suffer from this disease more often than men.
Clinical picture
Symptoms of pulmonary edema most often appear suddenly and increase very rapidly. Symptoms completely depend on the stage of the disease. The clinical picture of the interstitial and alveolar stages of pulmonary edema is very different.
According to the degree of progression of the main symptoms, the following forms of pulmonary edema are divided:
- Spicy. Symptoms of alveolar edema appear several hours after signs of interstitial edema appear. This form of pathology is most often diagnosed in the adult population. The cause may be a heart defect that occurs due to severe stress or vigorous physical activity. The acute form of pulmonary edema often accompanies myocardial infarction.
- Subacute. Lasts from 4 to 12 hours. Occurs due to fluid retention, mainly due to renal or liver failure. It occurs with congenital heart defects and anomalies of large vessels. Often occurs when lung tissue is damaged by toxins or infections.
- Lingering. It may last a day or more. It occurs in chronic kidney failure, inflammatory lung diseases and some systemic connective tissue pathologies.
- Lightning fast. Just a few minutes after the onset of the pathological process, the person dies. This pulmonary edema is the most common cause of death in myocardial infarction and anaphylactic shock.
Against the background of chronic diseases, pulmonary edema often begins at night. This is due to the prolonged horizontal position of a person. If the cause of fluid accumulation is a blood clot, a person’s condition may worsen sharply at different times of the day. Pulmonary edema in older people is especially difficult and often leads to serious consequences.
The main signs of pulmonary edema are quite specific and look like this:
- Severe shortness of breath is observed even in a state of complete rest. The patient's breathing is loud, bubbling, but quite frequent. You can hear the patient breathing even at a distance of several meters.
- Attacks of severe suffocation occur suddenly. The patient feels an acute lack of air, this is especially noticeable when lying on his back. In this case, the person takes a semi-sitting body position, in which it is easier for him to breathe.
- Lack of oxygen leads to severe, pressing pain in the chest.
- The work of the heart is greatly impaired, palpitations are noticeable.
- A cough occurs with strong wheezing, which can be heard even from a distance. When you cough, pink foam comes out profusely.
- When examining the patient, you may notice abnormal pallor and cyanosis of the skin. The person sweats profusely, and the sweat is cold and sticky. All these phenomena are associated with circulatory disorders.
In addition to these signs, confusion is observed. A person first becomes overly excited and is haunted by fears of death. As the disease progresses, excitement turns into inhibition and eventually the person may fall into a coma.
The mortality rate from pulmonary edema is very high. The prognosis depends on the form of edema and the speed of providing the patient with the necessary assistance. At the first symptoms of the disease, you should urgently call a doctor.
Diagnostics
Symptoms of pulmonary edema are very specific, but they do not always appear in a timely manner and in full, so diagnosis can be very difficult. If the patient is fully conscious, then the doctor listens to complaints and collects anamnesis. Thanks to this data, it is possible to determine the root cause of this pathology and try to eliminate it.
If the patient is unconscious, then a presumptive diagnosis is made based on an examination of the person. Based on the examination results, the doctor can suggest the causes of this pathological condition.
When examining a patient, the specialist pays attention to the pallor and cyanosis of the skin. Excessively pulsating neck veins and shallow, rapid breathing should alert the doctor.
The patient's pulse is weak and thread-like. The doctor may note a viscous cold sweat that covers the patient's body. When tapping the lung area, there is some dullness of sound over the respiratory organs. This indicates a high density of lung tissue. When listening to the lungs with a stethoscope, you can hear harsh breathing, which is accompanied by wheezing. Pressure with this pathology can increase significantly.
To clarify the diagnosis, a number of laboratory tests are required:
- General blood test - with this test you can see whether there is an infectious process in the body.
- Biochemical blood test - helps determine the causes of pulmonary edema. Based on the results of this analysis, it is easy to differentiate cardiac causes from other causes that were provoked by a decrease in protein in the blood. If the results of such an analysis show that the level of urea and creatinine is increased, then we can talk about kidney pathology, which became the cause of swelling of the respiratory organs.
- Analysis to assess blood clotting. Indicates edema that arose due to thromboembolism of the pulmonary artery.
The patient must undergo a blood gas test. If, according to the results of the analysis, there is a noticeable increase in carbon dioxide in the blood, then pulmonary edema can be suspected.
Some instrumental diagnostic methods are prescribed, these include:
- Determining the level of oxygen saturation in the patient's blood. With edema, this figure does not exceed 90%.
- Measurement of central venous pressure.
- Electrocardiogram. Allows you to identify cardiac dysfunction.
- Ultrasound of the heart helps to clarify the causes of pathological changes that were identified by the ECG.
The patient must be sent for a chest x-ray. This study allows you to confirm or refute the presence of fluid in the lungs. Pathology can be determined by unilateral or bilateral darkening, and if the edema is caused by a cardiac cause, then an enlarged shadow of the heart will be visible on the image.
Sometimes narrow specialists are also involved to clarify the diagnosis and prescribe treatment. This could be a cardiologist and an infectious disease specialist.
Treatment
Treatment is carried out only in a hospital. If the patient’s condition is too severe, he is immediately placed in the intensive care unit.
If a person has signs of pulmonary edema, it is necessary to urgently call an ambulance. Even during the transportation process, the patient is given first aid according to the approved protocol. Emergency assistance includes the following measures:
- The patient is placed comfortably in a semi-sitting position. In this position, breathing becomes much easier.
- Oxygen therapy is carried out according to indications. If breathing is very difficult, then tracheal intubation is performed and then artificial ventilation of the lungs is performed.
- Clinical recommendations for first aid require the patient to dissolve nitroglycerin tablets.
- If necessary, the patient is administered morphine for pain relief.
- To reduce blood flow to the right side of the heart and prevent an increase in pressure in the pulmonary circulatory system, venous tourniquets are placed on the patient’s legs. When applying bandages, you need to make sure that the pulse in the limbs is palpable.
Tourniquets can be applied for no more than 20 minutes. Remove the tourniquets after gradually loosening them.
Further treatment of pulmonary edema is carried out in the intensive care unit or intensive care unit. Health care workers monitor blood pressure, as well as cardiac and respiratory activity in such patients around the clock. Medicines are administered intravenously, most often into the subclavian vein into which a catheter is inserted. In the treatment of this pathology, drugs from the following groups can be used:
- Antifoam agents are often used for pulmonary edema. They consist of pure oxygen and ethyl alcohol vapor.
- If blood pressure is elevated and there are signs of myocardial damage, nitroglycerin is prescribed.
- Diuretics or diuretics, to quickly remove excess fluid from the body.
- Drugs to increase heart contractions.
- If severe pain is a concern, morphine-based medications are prescribed.
- If there are signs of thromboembolism, then anticoagulants are prescribed.
- If the heart is too slow, it is prescribed.
- For symptoms of bronchospasm, hormonal drugs are indicated.
- If the cause of the swelling is some kind of infection, then broad-spectrum drugs are prescribed.
In some cases, blood or fresh frozen plasma transfusion is indicated. The duration of treatment for this pathology can vary significantly. This depends on the severity of the patient's condition and the age of the patient.
Pulmonary edema is treated only in a hospital. Treatment at home is not carried out! At home, the patient can only receive emergency care.
Forecast
It is difficult to predict anything with pulmonary edema. The prognosis mainly depends on the cause that provoked the pathology. If the accumulation of fluid is not associated with heart disease, then the prognosis is most often good. The cardiogenic form is difficult to stop, so in this case the mortality rate is higher. The consequences of cardiogenic pulmonary edema in older people are especially sad. The survival rate throughout the year is only 50%.
The most difficult prognosis for the toxic form of pathology. In this case, recovery is possible only with the introduction of a high dose of diuretics, although a lot depends on the endurance of the patient’s body.
Sometimes it is quite possible and necessary to prevent this pathology, since the consequences of cardiogenic pulmonary edema are not always favorable. Prevention includes early detection and treatment of pathologies. Which can lead to excessive fluid accumulation in the body. If dangerous signs of pulmonary pathology appear, you should immediately call an ambulance.
