Pulmonary edema: symptoms, causes and consequences, emergency care, treatment

click fraud protection

Pulmonary edema is a life-threatening, very severe and acute painful condition associated with an abnormal accumulation of intercellular( interstitial) fluid in the lung tissue and inside the alveoli. That is, instead of the air that should get into the pulmonary vesicles, they get water, and the person, unable to breathe, literally chokes and dies. Therefore, in this article we will consider the causes, consequences and terms of treatment of pulmonary edema in an adult and a child, its symptoms and signs, the algorithm of emergency care.

What is pulmonary edema

Pulmonary edema is expressed in a sudden and acute sensation of lack of air that accompanies suffocation and cyanosis( blue) of the skin. Abnormal abundance of fluid in the lungs leads to a sharp disruption of its proper circulation, a disorganization of the gas exchange process, a decrease in respiratory function and a rapid development of oxygen deficiency in the heart structures, as the complete supply of lung cells to the air, oxygen saturation of the blood, and the process of excretion from the cellstoxic metabolic products.

Its varieties

There are two basic types of edema that are associated with a causative factor:

1. Membrane .This form happens if the body is affected by toxins. They can be exogenous( coming from external sources - pharmacological agents, poisons of insects and reptiles, ethanol, harmful substances of the atmosphere, chemicals) or endogenous( excreted by viruses, bacteria, helminths, fungi, parasitic inside the body).Toxins damage the walls of the vessels, and then the exudate from them penetrates into the interstitium - the connective tissue of the lungs.
2. Hydrostatic .A pathology of this type develops under abnormal conditions that cause the hydrostatic pressure to rise inside the vessels and then squeeze( exhale) through their walls the plasma part of the blood into the lung tissue and alveolar cavities.

Differentiate two forms( and stages) of the course of the pathology:

• Interstitial .The abnormal process in the lungs begins to progress when the volume of the transudate increases, which is released from small vessels into the space between the cells of the lung tissue. After this, the process of metabolism, the functions of cells and vessels are violated.
• Alveolar .This is a late stage of edema, when fluid that has percolated through the capillary walls into the area between the tissue cells penetrates the pulmonary alveoli. In conditions when all the alveolar vesicles are filled with liquid, the act of breathing is interrupted, oxygen does not fill the lungs - the body is dying.

For the rate of deterioration of the patient's condition and the increase of symptoms, certain stages are singled out:

Stages( forms) of edema	acute	subacute	protracted	fulminant
Duration, hour. Appearance of signs of alveolar edema after interstitial form	through 2 - 3	4 - 12	24 or more	several minutes
Causes of pathology	myocardial infarction, defects in the structure of mitral, aortic valves, more often after prolonged or acute neurologic stress, physical overload	fluid retention, acute liver failure, kidney failure, defects and defects of the myocardium, large coronary vessels, lung damage by toxins or infectious agents	chronic foreheadss weak renal activity, smoldering inflammation in the lung, scleroderma, vasculitis	extensive myocardial infarction, anaphylactic( allergic) shock and in severe acute

In chronic pathologies edema often it occurs in the night time, which is associated with a long lying position. With thromboembolism( overlap with a thrombus of the main vessel of the heart or lungs), the patient's condition deteriorates sharply at any time.

Now let's talk about the symptoms of pulmonary edema with heart failure and other cardiological problems.

How to identify a feature in your

With fulminant edema, all the symptoms of the pathology develop suddenly, rapidly increasing, and it is often impossible to save the patient. With a protracted form, the development of all the symptoms of the edema is not so fast, so there is a real chance to help the patient. The process of deterioration depends on the rate of transition of the interstitial form of the edema to the alveolar.

Primary signs of

Primary signs of an impending threat( usually in the interstitial stage):

• pressing, compressive chest pain due to acute oxygen shortage, as happens with drowning;
• the increase in the number of respiratory movements, the increase in signs of dyspnea( dyspnea) at rest with difficulty and inhalation, and exhalation;
• severe degree of tachycardia( abnormally frequent heartbeat, from 120 beats / minute);
• increase in the volume of dry wheezes with the gradual appearance of moist.

Further progression of the pathology

Further progression of the pathology( transition to the alveolar form):

• paroxysmal sensation of suffocation, which increases if the patient lies on the back;for this reason the patients try to sit down and lean forward, resting on the palms( orthopnea);
• breathing becomes more intense, it becomes superficial;
• an abundance of wet wheezes, bubbling and audible at a distance;
• skin is covered with sticky sweat with cold sweat drops;
• The hue of the skin becomes earthy, gray-lilac with a translucent mesh of subcutaneous vessels;
• from the mouth begins to emit foamy sputum, often a pinkish color due to the ingress of red blood cells( in severe cases, the foam goes through the nose).

• impaired perception, blood pressure drops, becomes weak and intermittent pulse, develops panic state with fear of death, deep loss of consciousness with the transition to coma.

For reasons of the occurrence of pulmonary edema, read below.

Which diseases and disorders may be symptomatic of

Pulmonary edema does not belong to individual pathological processes proceeding in isolation, but is a serious complication of internal diseases that have reached the critical stage. The etiology( origin) of edema is very different, and pathogenesis is not fully understood.

However, in the treatment of a particular group, internal diseases are distinguished in which edema develops especially:

1. Heart diseases in severe with left ventricular dysfunction( ventricular infarction) and blood retention in the small( pulmonary) circulation circle - vascular path from the right ventriclethrough the lungs to the atrium and vice versa: cardiac infarction with cardiogenic shock, cardiosclerosis( abnormal proliferation of connective tissue replacing working muscle fibers of the myocardium), atrial fibrillation, blockaderdtsa. Defects of heart structures .Of these, the most frequent is stenosis( narrowing of the lumen) of the mitral and aortic valves.
2. Coronary aortic dissection ( damage and rupture).
3. Pneumothorax ( penetration of air into the pleural space during an injury);
4. Acute dysfunction( disruption of the work) of the respiratory center ( asthmatic status, overlapping of respiratory tracts with foreign object).
5. Arterial hypertension of different origin.

In addition, the pathology is observed under the following conditions and conditions:

• pneumonia, progressive emphysema, severe, long-term asthmatic attack;
• introduction of pyogenic bacteria into the common blood network( blood infection or sepsis);
• severe poisoning, infection;
• anaphylactic shock in case of acute allergy to medicines, products, chemicals;
• affection of the central nerve trunks;
• embolism of the main artery of the lungs( clot lumen of the blood vessel);
• disease, which causes a decrease in the amount of protein in the blood( cirrhosis, illness or weak kidney activity).

Pulmonary edema can develop under these conditions:

• intravenous infusions of large quantities of drugs without stimulating urinary output;
• reception of excessive doses of some medicines( Fentanyl, beta-blockers, Apressin);
• Radiation damage to lung tissue, drug use, drowning, being in the highlands.

How to deal with it

Pulmonary edema is a condition that carries an extreme threat to life, often resulting in death of a person, therefore, at the very first manifestations of a respiratory disorder( especially with cardiac and pulmonary diseases), one should immediately call an ambulance or mobile resuscitation. Therefore, let's find out what is the incidence of emergency care for pulmonary edema and what is the algorithm of action.

First aid measures taken by relatives, colleagues, friends and passers-by with pulmonary edema before an ambulance arrives:

1. If a person has not lost consciousness, he is gently planted so that the thorax takes a vertical position.
2. Open the windows( in warm weather), the windows - in the cold.
3. Unfasten all clothing, pressing on the chest and pulling the belly( ties, belts, belts, tight jeans at the waist, women - cut the dress if it tightens the chest tightly).
4. Give the patient a nitroglycerin tablet( under the tongue) and Furosemide to remove excess fluid from the swelling tissues.
5. Provide a person with the ability to breathe through alcohol vapors to extinguish the selection of foam. In the conditions of a house, office, street, you can impregnate gauze with 96% alcohol, so that a person breathes through it.

It is best to use sublingual sprays( Nitrospray, Nitromint), which are more effective in an emergency situation - the onset of drug exposure is accelerated, and the dose is easier to vary than when taking tablets.

Inpatient treatment of

Specialists take the following measures:

1. Provide saturation of the lungs and blood with oxygen, conducting oxygen inhalations( 100%) through 96% alcohol solution, injecting into the nasal passages of the cannula or applying a mask to destroy the foaming. In a particularly threatening situation, intubation of the trachea is made, ventilation is carried out - forced ventilation of the lungs.
2. Intravenous injection of morphine hydrochloride 2 - 5 mg( if necessary - after 10 - 20 minutes - repeatedly).Morphine relieves the overexcitement of the nervous system and the fear of death, manifestations of dyspnea, dilates the vessels of the heart, brain, lungs, lowers blood pressure in the central artery of the lungs. Opiate is not used with low blood pressure and an obvious respiratory disorder. If the patient's breathing is depressed, a morphine antagonist, Naloxone, is prescribed.
3. Apply softly pressing strands to the upper third of the thighs( making sure that the pulse is palpable), taking them off after 10 to 20 minutes, slowly relaxing the pressure. This is done to reduce the flow of blood to the right heart chamber and reduce pressure.
4. Carefully use nitroglycerin in patients with symptoms of myocardial ischemia( necrosis of cells due to a violation of blood flow to them) and increased pressure to activate the work of the heart for pumping blood. First, 0.5 mg is given to the patient under the tongue( in a pre-moistened mouth, as the mucous membranes dry out during swelling).After that, through the dropper slowly inject the drug into the vein( 1% solution) no faster than 15 - 25 mcg per minute, gradually increasing the dose. All activities are carried out, constantly monitoring the pressure( not allowing the systolic drop below 100 - 110).
5. With the development of cardiogenic shock, Dobutamine is administered intravenously( 50 mg in a solution of sodium chloride in a volume of 250 ml), which increases the volume of cardiac output, increases the contraction of the heart muscle, increases blood pressure to normal figures. It has a specific and useful property - together with active stimulation of myocardial contractions, to expand the vessels of the heart, brain, kidneys, intestines, improving circulation in them. Dobutamine is administered via a dropper of 175 μg per minute with a slow increase in the dose to 300.
6. It is mandatory to perform diuretic therapy to increase diuresis, to reduce venous stasis in the lungs and to expand the capacitive( venous) vessels to reduce the burden on the heart. Intravenously, at a dosage of 40-60 mg, Furosemide is prescribed, gradually increasing the dose to 200 mg, Boumetamide, Burinex( 1-2 mg), Lasix( 40 - 80 mg).
7. With a strong increase in heart rate, ciliary abnormalities of the rhythm of contractions, cardiac glycosides are used by intravenously injecting a 0.05% solution of Strophantine( in a volume of 0.5-0.75 ml), 0.025% Digoxin( 0.5-0.75 ml) from 5% glucose or sodium chloride. But glycosides are not used during an acute heart attack, when the atrioventricular orifice is narrowed or infiltrated, at elevated pressure, because they are capable of causing backlash reactions, leading through certain physiological mechanisms to aggravation of the state of edema. Therefore, the worse the condition of the heart muscle, the more carefully used cardiac glycosides.
8. If swelling is accompanied by paroxysmal( severe acute attack) rhythm disturbances - ventricular tachycardia, flutter and atrial fibrillation - urgently apply electroimpulse therapy.
9. If there is a spasm of bronchi in the edema, Eufillin is administered, in addition to patients with acute infarction, hormones - Prednisolone, Dexamethasone.

Additionally and necessarily use such funds for pulmonary edema:

• with a small amount of blood protein - intravenously pour albumin;
• with symptoms of congestion of the coronary, pulmonary artery by a blood clot( embolism) - Heparin, Pentoxifylline, blood thinning and not adhering platelets to thrombotic clots( aggregation);
• with bradycardia( a dangerous slowing of the heart rate) - Atropine.

Bleeding in a volume of up to 500 ml in the practice of modern medicine is no longer used to remove pulmonary edema, but this technique is effective and can be the only rescue in circumstances where there are no other medical options.