Pulmonary edema: causes, symptoms, treatment. howperform a first aid

Update: December 2018

Pulmonary edema – life threatening pathology – requires rendering
emergency care and urgently hospitalize a patient.
the condition is characterized by an overflow of pulmonary capillaries,
transudation (exit) 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 with strong physical
loads.

Classification

Pulmonary edema as a complication occurs when dysregulation
the amount of fluid entering and leaving the lungs. Simply put,
with this complication, the lymphatic vessels do not have time to remove
excess of blood being filtered from capillaries. And because of the increased
pressure and low protein levels there is a transition of fluid from
pulmonary capillaries in the alveoli of the lungs. That is, the lungs are filled
liquid and cease to function. Causes of pulmonary edema
divided into two groups, and in the first place is the main –
heart disease:

  • Hydrostatic edema – due to disease, with
    which increases intravascular hydrostatic pressure and
    there is a flow of fluid from the vessel to the interstitial
    space, and then into the alveoli. Main cause of this swelling
    are cardiovascular diseases.
  • Membranous edema – occurs under the influence of toxins, with
    this disrupts the walls of the capillary or alveoli and the fluid exits during
    extravascular space.

There are two types of this complication: interstitial and
alveolar. This is essentially the stage of the whole process, since
the liquid overcomes two barriers (histohematic and
histoalveolar). Comparative characteristics of both
processes:

Interstitial Alveolar
Symptoms of pulmonary edema Dyspnea, cough, no sputum Cough, frothy sputum, rales are heard (dry, and then
wet)
Liquid barrier Histohematic (on the way blood-tissue) Histoalveolar (on the way alveolar tissue)
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 in her
cavity
without rendering honey. progression care Goes to the alveolar Suffocation death

Another classification – by degrees of severity.

  • Pulmonary edema: симптомы, причины1 degree
    предотечная
    – наблюдается диспноэ (небольшая одышка,
    characterized by a disorder in the frequency and rhythm of breathing) is possible
    bronchospasm.
  • 2 степень средняя – появляются умеренные
    wheezing, heard at a short distance, orthopnea (shortness of breath,
    forced to take a forced position – the patient is sitting hanging down
    legs).
  • 3 степень тяжелая – характеризуется выраженным
    orthopnea (man can only be in one
    position), rattling, audible at a distance wheezing.
  • 4 степень классический отек легких – тяжелое
    orthopnea, severe weakness and excessive sweating, rough rales,
    heard at a greater distance.

Causes and development

Cardiogenic – develops with acute left heart
failure

Diagram of the development of cardiogenic pulmonary edema

Withчиной ОСН (острой сердечной failure) может быть:

  • pathology as atria – mitral stenosis
  • and ventricle – myocardial infarction, myocarditis, hypertensive
    disease, cardiosclerosis, heart defects, resulting in reduced
    contractile function of the heart muscles.

With decompensated heart disease, with stagnation in small
Circle of blood circulation (which also happens in case of bronchial asthma,
emphysema of the lungs) in case of an increase in pressure in the capillaries and
untimely delivery of medical care may develop
pulmonary edema.

In children, cases of cardiogenic pulmonary edema are extremely rare.
The main reason for them are others: harmful poisoning
substances (for example, turpentine or kerosene fumes), shock,
inflammatory reactions, drowning.

Not cardiogenic

  • Iatrogenic (consequence of the actions of medical personnel) – develops
    at high speed parenteral significant
    number of blood substitutes or physical. solution.

    The development of iatrogenic pulmonary edema

  • how осложнение определенных заболеваний и состояний, в
    the result of which decreases the amount of proteins in the blood:

    • prolonged fever
    • starvation
    • pregnancy – eclampsia of pregnant women (see preeclampsia with
      pregnancy).
    • diseases of the liver and kidneys – with cirrhosis of the liver and kidney
      failure высок риск развития отека.
    • high physical activity
  • how результат поражения легких инфекционного характера
  • Allergic, toxic – food allergies and other
    allergic reactions, radiation damage to the lungs, inhalation
    cocaine (less frequently, overdose of methadone or heroin), high doses and
    prolonged use of aspirin cause aspirin intoxication
    (especially in old age). The mechanism of development of these types of edema
    lungs is the same as in infectious inflammation – toxic
    allergic agents and mediators damage the system
    surfactant.

    The mechanism of development of pulmonary edema of an infectious nature

  • Resulting from other reasons:
    • aspiration – hit in lungs of foreign masses
    • traumatic – chest injuries
    • shock – in all three cases, the pathology is associated with damage
      membranes
    • cancerous – the lymphatic system of the lungs is disturbed, i.e.
      fluid outflow is hampered
    • neurogenic – here the causes of pulmonary edema lie in the central
      mechanisms, with intracranial hemorrhage, with severe convulsions
      or because of a brain surgery, fluid may accumulate
      lungs.
  • With a sharp climb to high altitudes (3 km) can occur
    высотный отек lungs.
  • ARDS – acute respiratory distress syndrome occurs when
    injury, severe infectious disease, inhalation of toxins,
    lung infections, the integrity of the alveoli is impaired, and
    increases the risk of sweating in them the liquid from the vessels.
  • With a dramatic lung expansion process, for example with
    pneumothorax, with exudative pleurisy – edema occurs
    as a rule, on one side of the lung – one-sided.
  • Rare causes include pulmonary embolism when a clot
    blood enters the blood vessels of the lung and clogs them.

Scientists have found that athletes exposing themselves to enormous
физической нагрузке, имеют определенный риск получить отек lungs.
These are athletes on marathon distances, freedivers, scuba divers,
long-distance swimmers, climbers who climb
great height. Moreover, some of them after receiving
loads appeared mild edema, and in women this fact
came to light more often than men.

Symptoms

Человек субъективно ощущает следующие симптомы отека lungs.

In the initial stage (interstitial edema) With progression (alveolar edema) to the already existing
sensations join
  • severe inspiratory dyspnea (difficulty breathing), with increased
    breathing alone, that is not dependent on physical activity
  • increased sweating
  • dry hard paroxysmal cough
  • growing weakness
  • heart palpitations
  • cough increases lying down, so the person takes forced
    position – the patient is sitting with his legs dangling
  • anxiety
  • cough with a lot of frothy pinkish sputum
    colors
  • first wheezing, then bubbling, wheezing
  • suffocation
  • veins swell around the neck
  • acrocyanosis (outflow of blood from the limbs, they turn blue and become
    cold)
  • possible loss of consciousness
  • fear of death

Attention! When the initial symptoms of pulmonary edema are important
the shortest time to provide qualified honey. help therefore
should urgently call an ambulance.

Basic diagnostic methods

History taking when interviewing, the doctor finds out the correct treatment tactics
факторы, которые способствовали отеку lungs. Heart disease
provoke cardiogenic edema, others mentioned above –
not cardiogenic.
External review, at which the doctor reveals:
  • inspiratory dyspnea with retraction of intercostal spaces at
    inspiratory and supraclavicular fossa
  • forced position of the patient
  • cyanosis (blueing) of the face and acrocyanosis (blueing
    limbs)
  • bulging veins in the neck
  • dry cough or sputum
  • audible wheezing
  • excessive sweating
Auscultation (listening):
  • interstitial edema – hard breathing is determined,
    тахикардия (heart palpitations), сухие рассеянные, впоследствии
    wheezing
  • alveolar edema – sonorous crepitus, moist rales (starting
    from the base of the lungs, and then large bubble throughout
    surfaces), muffled heart tones, a canter rhythm is heard
    (heart rate that occurs when the heart muscle is damaged),
    accent II tone over the pulmonary artery (this means
    oscillations of pulmonary valves due to increasing pressure in
    small circle of blood circulation)
Percussion determined by the boxed tone of sound, dullness over
lower back lung, increasing the boundaries of the liver.
Palpation a weak, rapid pulse, filling of the neck veins,
determined by the degree of moisture of the skin.

An experienced doctor can easily determine the severity of the patient’s condition.
on skin moisture:

  • light – dry skin
  • moderate – forehead with perspiration
  • heavy – wet breasts
  • extremely heavy – wet breasts and stomach

Additional diagnostic methods

  • X-ray examination:
    • interstitial edema – blurred pulmonary pattern, reduction
      transparency of perineum departments
    • alveolar edema – changes in the basal and basal divisions in
      as a focal, diffuse (widespread) form or “wings
      butterflies. “
  • Electrocardiography – reveals signs of heart disease, and
    also overloading its left side.
  • Echo KG – is carried out with not acutely flowing pulmonary edema for
    determine the concomitant disease that provoked it
    complication.
  • Measurement of wedge pressure in the pulmonary capillaries
    (hydrostatic pressure) using a catheter inserted into
    pulmonary artery. This indicator is necessary for setting the correct
    diagnosis, as the JCLC increases with cardiogenic edema, and with no
    cardiogenic – remains the same.
  • Biochemical analysis of blood (transaminase) – also allows
    distinguish cardiogenic edema (transaminases elevated) from non
    cardiogenic (indicator in norm).

Differential diagnostics

Pulmonary edema is important to distinguish in time from bronchial asthma.

Pulmonary edema Bronchial asthma
Anamnesis Most heartfelt Allergic
Dyspnea Inspiratory (difficulty breathing) Expiratory (difficulty exhaling)
Breath Throbbing, wheezing, orthopnea Whistling involving auxiliary muscles
Sputum Foamy with a pinkish tinge Viscous, difficult to detach
Percussion Boxed tint sound, dull over some
by departments
Sound box
Auscultation Hard breathing, wheezing wet, large bubble The exhalation is extended, vesicular breathing with an abundance of wheezing,
humming dry rales
ECG Overload of the left sections Right heart changes

First aid for edema

Before the arrival of the doctor you can do it yourself:

  • Give the patient a sitting position or half-sitting with deflated
    down feet
  • Provide reliable access to a large peripheral vein (for
    subsequent catheterization)
  • Organize fresh air access
  • Give the patient to inhale vapors of alcohol (96% – adults, 30% –
    children)
  • Make a hot foot bath
  • Use on the limbs venous harness (from 30 minutes to 1
    hours)
  • Constantly monitor breathing and pulse.
  • In the presence of nitroglycerin and not reduced arterial
    pressure – 1-2 tablets under the tongue.

Emergency care for pulmonary edema provided by an ambulance team
assistance before arrival at the hospital is as follows:

  • Oxygen therapy (active oxygen saturation)
  • Foam suction and anti-foam therapy (oxygen inhalation
    through a solution of ethyl alcohol)
  • Diuretic therapy (lasix, Novurit) – removes excess
    fluid from the body, with low blood pressure using reduced doses
    drugs
  • In the presence of pain – taking painkillers
    (analgin, promedol)
  • Other drugs depending on the level of blood pressure:
    • high – ganglioblockers (contribute to the outflow of blood from the heart
      and lungs and inflow to the extremities: benzogeksony, pentamine),
      vasodilators (dilates blood vessels: nitroglycerin)
    • normal – reduced vasodilator doses
    • low – inotropic agents (increase myocardial contractility:
      dobutamine, dopmine).

Treatment of pulmonary edema

In the conditions of a hospital, the therapy is continued.

  • Oxygenotherapy – oxygen inhalation with ethyl alcohol to
    extinguish foam in the lungs
  • Narcotic analgesics (painkillers) and neuroleptics
    (drugs to reduce psychomotor agitation): reduce
    hydrostatic pressure in the pulmonary vessels and reduce the flow
    venous blood. Preparations: morphine, fentanyl
  • Diuretics – reduce the volume of circulating blood, produce
    dehydration of the lungs: furosemide
  • Cardiac glycosides (provide cardiotonic effect):
    strophanthin, korglikon
  • Other drugs for the treatment of pulmonary edema, depending on
    blood pressure (see above)
  • Removal and prevention of bronchospasm: aminophylline, aminophylline
  • Glucocorticosteroids, surfactant therapy: used when not
    кардиогенном отеке lungs.
  • For infectious diseases (pneumonia, sepsis) – antibiotics
    broad spectrum.

Important to know: cardiac glycosides are generally prescribed to patients.
with moderate congestive heart failure;
glucocorticosteroids for cardiogenic pulmonary edema
contraindicated.

Prevention

With сердечной failure в хронической форме назначают
ACE inhibitors (drugs to treat hypertension). With
recurrent pulmonary edema apply isolated
blood ultrafiltration.

Also prevention is to avoid the factors
pulmonary edema: timely treatment of diseases
heart, lack of contact with toxic substances, adequate
(not increased) physical and respiratory load.

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